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Back Surgery Should Not Be Taken Lightly; About Brown Fat and Obesity

Dear Dr. Roach: My son, 55 years old, had groin pain and was told he needed a new hip. Since the surgery, he has been in constant pain. Many doctors say it is his back, and he might not have needed the hip surgery. He sent his films to a clinic in Florida that does laser spine surgery, and they say he might be a candidate. Could you give me some information about it? He is reluctant to have another surgery. It’s very expensive, and insurance won’t cover it. — H.J.

Answer: I can’t tell you if your son needs another surgery. Neither can the Florida laser spine surgery clinic. Only after a really comprehensive exam, review of the films, CT or MRI scans he may have had, and especially a long discussion with your son, should another surgery be considered.

As far as laser spine surgery goes, there certainly are people who have had great results, and some who are worse after the procedure. I don’t know of any good studies comparing one against another. But it worries me that insurance doesn’t cover it and that a neurosurgeon at the Mayo Clinic wrote that they don’t use or recommend it at their hospital (which is the case at many other teaching hospitals as well).

Dear Dr. Roach: I recently heard about brown fat. I had never heard of this fat, and was especially interested that this particular fat burns regular fat. If this is true, then it might have a bearing on the serious obesity problem. — R.C.

Answer: Brown fat is a metabolically active fat that was previously thought to exist mostly in babies. However, some recent studies have shown that brown fat can become active in lower temperatures, burning off calories to keep us warm. Researchers are trying to find a way to use this discovery for weight loss. Overweight people have little or no brown fat. It’s not clear to me whether the excess weight is because they don’t have brown fat, or the other way around. In any event, these findings about brown fat are interesting, but not yet of practical use against obesity.

Dear Dr. Roach: I have been diagnosed with Holmes-Adie syndrome. I cannot find much information on this syndrome other than that it is rare, caused by a virus or bacteria and affects the autonomic nervous system. What is the autonomic nervous system? Can you provide any information on this condition, if it will progress and what to expect? What kind of doctor treats it? — N.W.

Answer: The Adie pupil, also called Adie’s tonic pupil, is found when the eye loses part of its nerve supply. This causes one pupil to be bigger than the other during light exposure but smaller than the other when looking at objects close up. An Adie’s pupil usually occurs without other problems in the autonomic nervous system, but it can occur alongside other problems, such as Ross syndrome, where the Adie pupil is associated with abnormal reflexes and partial loss of sweating. Syphilis causes a similar pupil, but on both sides, in which case a test for syphilis should be done.

An eye doctor can help fit special glasses with one lens that’s different from the other to help correct the vision issues that may occur. Fortunately, most cases do not progress.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or write to P.O. Box 536475, Orlando, FL 32853-6475.