Obesity Management, Stop the Bleed, and Medicine in the Mark Twain Era Highlights Alliance Fall Conference

Thanks to all who contributed to making the Alliance Fall Conference in Hannibal October 29–30 such a fun-filled and informative two days – especially coordinator Sandra Murdock who helped organize the events, decorated the tables with Halloween fare, and kept track of reservations. We had a good attendance. Sandra greeted everyone at the registration table on arrival and handed out festive tote bags. Everyone commented on the excellent facilities, comfortable rooms, and welcoming staff at the Holiday Inn Express opposite the Hannibal Medical Center. An excellent lunch was catered by Fiddlestiks, a local restaurant whose owner gets up early to bake her own bread and cookies, and did not disappoint!

Our Tuesday afternoon program included speakers from the Hannibal Clinic who were recommended by Sandra Ahlum, MD. Our first speaker was Eric Meidl, MD, an internist specializing in obesity mangement working closely with the bariatric surgical team. He spoke on the current management of obesity and discussed the pros and cons of various weight loss therapies and current trends, including intermittent fasting. Some understood this to mean the popular 16:8 diet in which one eats only during an 8-hour period and fasts the remaining 16 hours. (Jennifer Anniston and Hugh Jackman have done this.)

Dr. Meidl says there are many ways to accomplish this. For his obese patients he plans a custom diet to fit their needs, recommending eating only 500 calories on certain days with a larger planned caloric intake on the other days. His usual recommendation is to follow the 500-calorie intake on Mon-Wed-Fri. This is an effective weight loss method. (Jimmy Kimmel follows a similar 5:2 pattern of 5 days fasting, 2 days eating normally.) Dr. Meidl notes that after some time adhering to the diet, less food is desired on the in-between days. He mentioned that steady weight loss and good maintenance is healthy; yo-yo dieting is not. He discussed the current bariatric surgical advances and newer medical approaches to obesity. His talk stimulated much discussion and he fielded questions on childhood obesity, set points, getting past a weight loss plateau, and changes in metabolism with aging.

Patricia Hirner, MD, is a general surgeon and presented the American College of Surgeons new initiative called Stop the Bleed. This was a hands-on course aimed at the general public on how to control hemorrhage at a trauma site, such as a road traffic accident or a shooting. Sadly, the reason this ACS program was developed was because of reports after the school shooting at Sandy Hook that one-third of the children who died could have survived if those around them had known how to control bleeding. Michael Bukstein, MD, a vascular surgeon at the Hannibal Clinic, assisted in the demonstration which included the correct methods of applying compression to a bleeding wound, packing the wound with clean cloth or hemostatic gauze, and the use of tourniquets. In the old Girl Scout days, we were taught to use anything we could devise for a tourniquet and to release the pressure after 20 minutes to allow some blood flow. That is no longer recommended; a professional tourniquet should be used that remains on until the patient is transported to medical care.

The lightweight velcro tourniquet Dr. Hirner showed can be applied like a blood pressure cuff; a small rod is turned to tighten the cuff until the bleeding stops. It is then snapped in place and a tag is labelled with the time the bleeding stopped, remaining on the injured patient while they are transported. Dr. Bukstein says he can restore circulation to a limb up to six hours after a tourniquet is applied. Even if a limb cannot be saved, wearing the tourniquet gives the patient a much better survival rate. Dr. Hirner recommended that everyone carry a trauma kit with these contents in the glove compartment of their vehicles.

Our Tuesday evening event was held at the Hannibal Country Club. Sherry and Michael Bukstein are members and had secured the venue for us. Our after-dinner speaker was Henry H. Sweets, III, the Curator and Executive Director of the Mark Twain Boyhood Home and Museum. Alliance member Mary Catherine Heimburger invited Henry, a childhood school friend, on our behalf. Henry grew up in Hannibal and is considered an international expert on Mark Twain. He spoke on Medicine and Pharmacy in the time of Mark Twain. He described Samuel Clemens’ early life and how the family came to live in Hannibal.

It is hard to imagine managing severe illness and injury without anesthesia, antibiotics and analgesics, not to mention antisepsis. Remedies from plant roots such as calomel and jallup (jalop) were used as purgatives and fungicides which would have been quite ineffective against the cholera epidemic of 1849 or various later challenges with yellow fever. Clemens contracted measles when he was ten and almost died. Dr. Sweets led us through the life of Clemens, his presentation being peppered with Twain quotes and a few Norman Rockwell depictions of Twain’s stories. The fifteen original Rockwells, (except one!) were on display in the Mark Twain Museum at the time of our visit. Dr. Sweets was an engaging speaker and provided entertaining and interesting information.

Missouri State Medical Association Alliance President Gill Waltman (left) welcomes from left, Drs. Michael Bukstein, Patricia Hirner, and Erik Meidl to the MSMA Alliance’s Fall Conference in Hannibal on Oct. 30. Drs. Bukstein and Hirner presented on the ASC program Stop the Bleed, while Dr. Meidl spoke on Obesity Management. The physician members of MSMA are all from the Hannibal Clinic.

Missouri State Medical Association Alliance “rises to the AMA Alliance Peanut Butter Challenge” by collecting and donating jars of peanut butter to a Hannibal Food Bank.

Several of us met downtown on the riverfront after the board meeting on Wednesday morning. After lunch at the Mark Twain Brewing Company, where we had a private upstairs room and a view of the river, we went on a tour of the Mark Twain Boyhood Home and Museum.