Q: My aunt needs a total knee replacement, and her doctor told her that she should have bariatric surgery (she’s very overweight) before she has the knee surgery. I think it’s a good idea, but she’s angry about it. What can I tell her? -- Adele C., Delphi, Indiana
A: She may be angry because knee pain and excess weight make it difficult for her to lose weight on her own and she simply wants the doc to make it all better. However, the less she weighs at the time of the operation, the better her recovery will be.
There’s a just-released study from the Hospital for Special Surgery in New York City that found obese people who had bariatric surgery before total knee replacement had a much, much higher quality of life for the rest of their lives than obese folks who had TKR without first undergoing bariatric surgery and losing weight. The researchers also found that weight-loss surgery followed by TKR (two years later) saved thousands of dollars in lifetime health-care costs for both insurance companies and patients.
The downside? She will have to put up with her bad knee as she heals from the weight-loss surgery and then loses weight. Upside? Most likely, she’ll have a longer life, with more fun and less disability.
The bottom line: Every pound she loses takes four pounds of pressure off her sore knee(s), and that relieves pain big time. If it’s still possible for her to get around and she’s not in too much pain, getting bariatric surgery before the TKR also may help her avoid obesity-related complications of knee surgery, such as infection, problems with wound healing and cardiovascular issues. Also, when she finally has that new knee, weighing less will speed her recovery and help her get back into the swing of things.
Q: I’m scheduled for a C-section and concerned my baby won’t get the good gut bacteria she needs because she isn’t going to pass through the birth canal. My doctor doesn’t think rubbing bacteria-rich vaginal fluids on the baby right after birth is worth the risk, but I think the evidence is pretty convincing that it’s a good step. What do you think? -- Josie F., Portland, Oregon
A: You’re correct that a newborn’s gastrointestinal tract receives intestinal- and immune-strengthening bacteria as the child passes through the birth canal. Research also shows that a newborn delivered by Caesarean section doesn’t receive the same bacterial infusion as an infant exposed to Mom’s vaginal fluids. And scientists speculate that this bacteria gap may be one cause of the increased risk for Type 1 diabetes, asthma, obesity, allergies and inflammatory bowel disease among kids born via C-section.
As a result, researchers have experimented with slathering vaginal fluids from moms all over newborns delivered by C-section: Turns out that it partially restores an infant’s biome -- particularly on the skin and in the mouth. However, bacteria colonizing an infant’s gut remain significantly different from the gut biome of vaginally delivered infants.
So do these experimental results mean that it’s smart to have your doctor apply your vaginal fluids to your newborn, or to do it yourself at home? Well, you should know that the fetus also acquires vital bacteria from the placenta while still in the womb. And recently researchers suggested that for women delivering by C-section, a much safer way to ensure that a child develops a healthy gut biome is to breastfeed (the milk is a creamy, bacterial soup!) and have the mom take a probiotic, while avoiding unnecessary antibiotics.
Like your doc, researchers fear that your baby might develop “severe infections from exposure to potentially harmful vaginal pathogens ... [and] the small risk of harm cannot be justified without evidence of benefit.” So if possible, it might be smart to rely on breastfeeding until we know exactly why passing through the birth canal is so beneficial to a newborn; there are so many plusses for mother and child.
Mehmet Oz, M.D. is host of “The Dr. Oz Show,” and Mike Roizen, M.D. is Chief Wellness Officer and Chair of Wellness Institute at Cleveland Clinic. Email your health and wellness questions to Dr. Oz and Dr. Roizen at firstname.lastname@example.org.