Surgical hope for obese teens

Dr. Michael Snyder and his team, above, prepare a patient at Rose Medical Center's new teen-only bariatric surgery center. (Photos by John Prieto, The Denver Post )

Kat Borst tried low-carb and no-carb and South Beach and Weight Watchers and so many other diets she "can't even list them all." None worked.

So at 17 years old and 280 pounds, Borst underwent surgery to squeeze her stomach smaller. She's lost 54 pounds since June and now hits the gym with her dad, even though she couldn't climb a flight of stairs without wheezing before.

Borst's weight loss, and the success of other teens who've had Lap-Band or gastric-bypass surgery at Rose Medical Center in Denver, have led the hospital to open a new bariatric program for teens — the first of its kind in Colorado.

The new center comes as childhood obesity has reached epic levels — about 17 percent of American children and teens are considered obese — but also as controversy looms about the safety of bariatric surgery for adolescents.

The program at Rose is tailored to teens, with several weeks of pre- and post-surgery sessions on nutrition, psychology and behavioral changes.

"Being 17 is really hard," said Dr. Michael A. Snyder, a bariatric surgeon who will direct the center. "Being a teen with bariatric surgery is very difficult. Being a morbidly obese teen is a total nightmare."

Snyder, who has done more than 2,800 bariatric surgeries and developed a special high-nutrition food for his patients, said he makes sure teens "are ready for a life-long commitment" before he performs surgery, which costs about $9,500 and is only sometimes covered by insurance. For most adolescents, Snyder places a Lap-Band, which is gradually tightened to reduce stomach capacity to about 10 to 20 percent of its original space.

It should take about 4 ounces of protein — a chicken breast about as big as a computer mouse, for example — to make a patient with a Lap-Band feel "Thanksgiving full" for two or three hours, Snyder said. The bariatric center counsels teens not to waste calories on frappachinos or sodas or really anything without protein — otherwise they don't lose the weight and could suffer from malnutrition.

Doctors disagree on rules

Snyder, one of few bariatric surgeons in the state who will operate on people younger than 18, said the ideal patient is at least 100 pounds overweight and has tried dieting and exercise without success. The doctor cites studies showing a less than 3 percent chance that a morbidly obese person will lose the excess weight and keep it off on their own.

"It's the safest bet in Vegas," he said. "If you are morbidly obese, the rules are different for you."

But other physicians argue Lap-Band and gastric-bypass surgery on adolescents is irresponsible and unsafe.

"I am so disgusted with this," said Dr. Wendy Scinta, a pediatric bariatrician on the board of the American Society of Bariatric Physicians. "In children, it's still considered experimental."

Scinta, who runs a medical weight-loss clinic for children and teens in Syracuse, N.Y., said adolescents who have bariatric surgery could end up with severe vitamin deficiencies and require surgery later to remove "elephant skin," the kind that hangs off the body when weight loss happens too quickly without maintaining muscle mass.

"It's kind of young to be going through something so drastic," she said. "We're at the point where the obesity epidemic is happening faster than we can get our arms around it, but especially with children, we do

Kat Borst, 17, in the Idaho Springs Cemetery. She had Lap-Band surgery in June and has lost 54 pounds so far. ( | )

have some time. We need to give them a shot at doing something less aggressive at first."

At Scinta's clinic, kids take medication to control their insulin levels, they learn — with their parents — to change the family diet to five small meals per day, and they are hooked up with pedometers and an exercise program. Childhood obesity often is caused by family or medical problems, Scinta said.

"Kids are easy," she said. "You really give them their life back or give them a life if they have never had one."

Scinta said she would recommend bariatric surgery — and she never has for a child or teen — only for a kid who weighed 600 or 700 pounds, couldn't get out of bed and was "truly on death's door."

Doctors said it's often difficult to discern the parents' desires from the child's when considering bariatric surgery for an adolescent.

"The hardest thing in the pediatric population is determining who is deciding they should have surgery," said Dr. Scott Fisher, director of bariatrics at Penrose-St. Francis Health Services in Colorado Springs. "Is it society? Is it the parents who are embarrassed of their child's weight? For 40-year-olds, it is because they are choosing themselves to make themselves healthier."

The Penrose bariatric surgery center has operated on only 10 to 15 teens in the last eight years, Fisher said.

Diet still a challenge

Borst, who is 18 now and working toward her goal weight of 145 pounds, wishes she would have had her Lap-Band surgery sooner in life. She struggled with her weight since age 4, was ridiculed throughout elementary school and left high school for an online program because of all the teasing.

Now she's planning on college next fall.

"I'm getting more confident," she said. "It's not fully built up yet because I'm still pretty big."

Still, Borst's life is different now. Before her surgery she "was feeling like absolute death." Now she enjoys hopping on a treadmill or stationary bike and playing badminton. Her clothes, she said, are "falling off."

Changing her diet has been the biggest challenge.

"I'm not going to lie; I have a lot of spells where I lose my determination," she said. "I get disappointed in myself. Every teenager that goes into this has to know it's not easy."

Jennifer Brown: 303-954-1593 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it

Use tech to monitor aging parents

By Kim Komando

January 2011

Thanks to new technology, you can have peace of mind without curtailing your parents' autonomy or privacy.

Monitoring your parents

You want to keep watch over your parents. There are several options for this. You can set up your own system using webcams or security cameras. webcams start around $50 and connect to a PC. Get two webcams so you can communicate with your parents using a free program like Skypefor video chats.

Security cameras start around $100 and connect directly to a wired or wireless network. You can monitor your parents' home from any Web browser. Point the cameras at high-traffic areas like the kitchen. You can get e-mail or text alerts when motion is detected. Choose cameras with a two-way intercom for communicating.

You'll want immediate notification if your parent falls. Wellcore's personal emergency response system ($200 plus $50 monthly) clips to a belt or clothing. It is about the size of a cellphone. It detects when the wearer falls. A specialist contacts the wearer. The specialist sends help and notifies family, or the wearer can press a button to request help.

You may prefer a complete monitoring service. Sonamba ($550 plus $40 monthly) monitors sounds and movements. It sends periodic messages to caregivers. Sensors connect wirelessly to a small box that looks like a digital photo frame. The box reminds parents of appointments and to take medication. A portable panic button summons caregivers or emergency services.

Other services to consider are Healthsense, SimplyHome and QuietCare.

Your parents should have a cellphone. You can check in periodically or contact them with reminders. It also helps in an emergency. The Just5 cellphone ($90) is ideal for seniors, thanks to large buttons and simple features. An SOS button dials five pre-programmed numbers until the call is answered. Unlimited calling and text runs $40 for 30 days.

Monitoring your parents' health

Microsoft's HealthVault can help monitor your parents' health. It downloads logs from a variety of manufacturers' gadgets. For example, it works with some Omron blood pressure monitors (starting around $65), Bayer blood glucose monitors (starting around $30) and Tanita scales (starting around $210). View the logs yourself or share them with doctors.

Another option is HoneywellHomMed's Sentry Telehealth Monitor. It guides users on measuring vital statistics and transmits the data to a health care professional. Speak to your parents' doctors before investing in a system. Not all doctors will monitor the data.

Help with medications

It's easy to forget to take medications. If your parent takes multiple medications, things become more confusing.

The TabSafe smart pillbox provides visual and auditory reminders to take medication. Press a button to dispense the correct pills. It sends text messages to confirm pills have been dispensed. TabSafe calls your parent and two others if a scheduled dose is missed.

TabSafe connects via landline to a website where prescription data can be tracked. It also helps with refills. TabSafe can also keep a log of vital stats like weight, blood sugar and blood pressure. TabSafe isn't cheap; it is $1,100 to buy or $50 to $100 monthly to rent.

Vitality's GlowCaps attach to standard pill bottles and connect to a cellular network. When it's time to take medication, they flash and play a sound. They also connect to wireless reminder light plugs and can call a phone. Additionally, they order refills when necessary. Finally, they send a weekly report to the user and their doctor.

A GlowCaps starter kit runs $100. This includes one pill cap, a night light and a six-month subscription. Subscriptions are $15 monthly thereafter.

Kim Komando hosts the nation's largest talk radio show about computers and the Internet. To get the podcast or find the station nearest you, visit www.komando.com/listen. To subscribe to Kim's free e-mail newsletters, sign up at www.komando.com/newsletters. Contact her at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Bilski Followup

By Jonathan Erickson, July 01, 2010

The U.S. Supreme Court recently had its say regarding the case of Bilski v. Kappos, a case that important ramifications for software developers. To get a clear understanding of the Supreme Court's decision, we recently spoke with Craig Hemenway, a partner in Dorsey Whitney Intellectual Property practice group.

Dr. Dobb's: Can you give us a snapshot of Bilski? A quick historical account of the case.

Hemenway: In Bilski, the Federal Circuit was asked to rule on the patentability of a method for hedging risks in trades. The Circuit took the opportunity to set out a test for the patentability of business methods. Specifically, the Federal Circuit endorsed the so-called "machine or transformation" test, in which a method or process is only patentable subject matter if it is tied to a particular machine or transforms an article in some fashion.

Dr. Dobb's: What is the core legal issue at stake?

Hemenway: The Supreme Court granted certiorari and issued its decision in Bilski v. Kappos on Monday. In the decision, the Court unanimously upheld the Federal Circuit's ruling that Bilski's claims were not patentable, stating that the claims covered nothing more than an abstract idea. The Court likewise held that the "machine or transformation" test is not an exclusive test, but indicated it could still provide a good clue as to the patentability of a method.

Dr. Dobb's: What did the Supreme Court's decide?

Hemenway: The Supreme Court split on the issue of whether or not business methods should be patentable at all. Four Justices agreed that certain business methods could be patentable but declined to provide guidance or examples. In this portion of the opinion, Justice Kennedy indicated that "new technologies may call for new inquiries." In short, Kennedy acknowledged that inventions today may be different than inventions seen in the so-called "Industrial Age" and that an industrial-era test may not be appropriate now. Given the similarities between business method claims and software claims, much of this discussion is germane to software patents as well.

Four other Justices filed a second opinion that business method patents should never be patentable. This opinion suggests that business methods were not considered patentable historically, and so should not be considered patentable subject matter now.

In short, business methods and software still may be eligible for patent protection and the "machine or transformation test," which could exclude many such inventions, is not the sole law of the land for determining patentability. However, the Supreme Court left ambiguity in place by refusing to articulate any particular patentability test. This, it appears, will be left up to the Federal Circuit and the Patent Office. Given the Federal Circuit's long history with patent law, perhaps this was the wisest possible choice.

Dr. Dobb's: How will this affect software developers?

Hemenway: Software developers should continue to seek patent protection where appropriate and possible. However, developers and companies need to realize that the law is again in a state of flux and a new test may come out that could -- again -- change the playing field. Thus, although software patent applications are legitimate and valid, one should prepare for the possibility that future rulings could impact existing patents. I would suggest continuing to include at least some claims in software and business method patents that satisfy the "machine or transformation" test to ensure that future rulings don't strip issued patents in these areas of all enforceability. After all, if the "machine or transformation" test is too restrictive in view of Bilski, then any claims satisfying its requirements should likewise meet the (presumably) relaxed standards of the future.

Dr. Dobb's: How will this decision affect software users?

Hemenway: Software users shouldn't see much of an impact from this ruling. In most cases users have legal copies of software in the first place and software is also protected by copyright. To the extent that patent coverage for software is expanded by Bilski, it may lead to an uptick in patent infringement lawsuits against developers, distributors and manufacturers.

Dr. Dobb's: Thanks for your time.

Impervious industry

How translation businesses sailed through the recession.

By Diane Hess

Like any new business owner, John Labati, chief operating officer of G3 Translate, was worried in mid-2008, when the financial crisis seemed to be sucking the life out of the U.S. economy.

Determined not to let the macro environment pull down his translation services firm, then two years old, Mr. Labati reviewed his budget. He nixed plans to add to his eight-person staff, reduced his marketing budget by 10% and began to offer tiered pricing.

Meanwhile, G3 Translate got a surge in calls from businesses looking to take advantage of overseas markets.

“More than a dozen companies in the consumer goods and pharmaceutical sectors came to us in late 2008 and 2009 to translate surveys and marketing materials as they decided whether or not to launch products in Europe and Asia,” says Mr. Labati.

Furthermore, a handful of manufacturing companies, experiencing growth in their Latin American and European businesses, hired G3 to translate instruction manuals. Rather than declining, revenue grew 30% in 2009, to $2.4 million.

The labor-intensive translation industry—much of it based in multicultural New York—is sustained by one crucial factor: No one has invented a cheap technology able to cope with the complexities of translating a language and culture. Even in the hard-hit financial sector, demand rose for translation services as companies reached out to reassure overseas clients that they weren't going under.

“The headlines were startling, and I thought I was going to have to change my business plan entirely,” says Leticia Molinero, president of Leticia Molinero Translation Studio, “But on the contrary, banks increased their market outreach to clients abroad.”

One of Ms. Molinero's customers, a major private banking corporation focused on Latin America, reassured clients through Spanish and Portuguese newsletters, fact sheets and other missives that their assets were protected. Revenue at Leticia Molinero Translation Studio in 2009 rose 15%, to $200,000.

Long-term trends have also boosted the field. U.S. government spending on language services rocketed to $1 billion last year from $100 million in 2000. The wars in Iraq and Afghanistan, especially, have increased the need for translators.

SPEAKING UP

Global demand for translation services has grown 15% to 20% since 2006, according to research firm Common Sense Advisory Inc.
The American Translators Association has 11,000 members, up 10% in the past two years.

2,300 people came to ATA's conference in New York City this year, up from 1,600 the previous year.

Locally, the rising number of immigrants has also had an impact. At language services provider Geneva Worldwide Inc., where government contracts make up 85% of business, revenue grew 15% in 2009, hitting $5.75 million.

“The government can't just say that it is going to stop servicing the Chinese-speaking community, for example,” says Craig Buckstein, chief operating officer at Geneva.

Among other assignments, the 107-year-old family business sends 50 to 70 interpreters daily to the Administration for Children's Services in New York. They assist with family counseling and help caseworkers perform investigations when there are claims of abuse or neglect.

Marian Greenfield, owner of msgreenfield Translations and a former president of the American Translators Association, has seen 30% revenue growth on the part of European clients since 2009, as a weaker dollar has brought more foreign firms her way.

“In a rough market, you are looking to sell your services wherever you can,” says Ms. Greenfield. “Even though there was a recession in the U.S., many European companies were looking to pick up translation services here.”

For his part, Mr. Labati of G3 Translate expects revenue to increase another 20% this year. He took advantage of the drop in commercial real estate rates and signed a lease in a new location for an additional 2,000 square feet. And the hiring plans are back on the table.

Aurora expanding school-based clinic program

By Yesenia Robles
The Denver Post

Posted: 09/19/2010 01:00:00 AM MDT

After two years of serving students' medical needs through a school-based clinic, Aurora Public Schools has decided the need is great enough to open a second clinic in October.

Rocky Mountain Youth Clinics operates the clinic at Crawford Elementary in Aurora, and has seen the number of patients who use it double from 1,000 in 2008 to 2,000 in 2009. The new clinic will be at Laredo Elementary.

Larry Wolk, executive director of Rocky Mountain Youth Clinics, expects the second clinic will see at least 1,000 students a year.

"We know there are children who miss a lot of school because they have some conditions that are not taken care of," said Mary Beth Rensberger, director of health services at Aurora Public Schools.

"When we can get kids down the hall to a same-day appointment rather than waiting weeks sometimes," she said, "it helps get them back to school sooner."

Denver Health operates 12 similar school-based clinics at Denver Public Schools.

Marisol Vizcaya, an Aurora mom of two, said she's glad the clinic program is expanding.

"They were very professional, and I really like the way they talk to kids," she said.

Her daughter is enrolled at another Aurora school, and her son, Gael Fierro, 3, has had stomach problems since birth.

Gael has now begun seeing a specialist for the first time this year after getting an immediate referral from the staff at the Crawford Elementary clinic.

Vizcaya said that before finding the clinic at the school, she had struggled to find a doctor who would see Gael because he'd lost his eligibility for Medicaid and had not yet received approval from CHP Plus.

At the Rocky Mountain Youth Clinics, children from the community are not turned away for inability to pay or lack of insurance, Wolk said, adding that the majority do have Medicaid or CHP Plus.

Wolk said the need for the clinic doesn't stem solely from lack of health care, however.

"It serves a social need too. It's more convenient than making them come all the way to a hospital," Wolk said.

Wolk founded the nonprofit with the vision of helping children who need health care, but don't have it readily accessible.

Rocky Mountain Youth Clinics has operated school-based clinics across Colorado since 1996 in areas such as Montrose, Fort Collins and Fountain. It has turned over many of those clinics to local organizations or doctors. No such plans exist for the Aurora clinics.

The clinic model is more sustainable if the people who run it also live in the community, Wolk said. The company operates three traditional clinics in Thorton, Aurora and Denver offices. "We have our three clinics here, so we feel we can provide a lot more services here," he said.

Rocky Mountain Youth Clinics also operates two mobile clinics — one dental and one medical — donated by the Ronald McDonald Foundation.

The mobile clinics rotate among Aurora and Denver public schools. Later this year, a third mobile clinic will be opened, offering dental and medical services; it will serve Aurora and Denver, as well as rural districts.

In January, Rocky Mountain Youth Clinics will also open Colorado's first "Grow Clinic" at its Thornton office.

The "Grow Clinic," copied from a Boston model, will address the needs of children who are malnourished, over- weight or underweight. Parents will receive "pantry prescriptions" for healthy food, which they can then fill at the clinic's food bank, also at the Thornton facility.

Wolk said Rocky Mountain Youth Clinic staff have become "experts at serving pediatric populations in need," and part of knowing how to serve those populations is going beyond clinic visits. The "Grow Clinic" and events such as bicycle-helmet giveaways are a few examples.

Aurora district health-services director Rensberger said community members have noticed and support the clinics.

"It has been a very positive phenomenon," she said.

Yesenia Robles: 303-954-1372 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it