It doesn't smell good, but it smells better than it used to.
June 16, 2016 3:04 PM   Subscribe

On Tuesday, the AspireAssist (previously), a non-surgical weight loss device that allows patients to drain up to 30% of the food from their stomachs before the calories are absorbed, was approved by the FDA. Any resemblance to fictitious devices is presumably unintended.
posted by amnesia and magnets (71 comments total) 10 users marked this as a favorite
 
How do they get to call it "non-surgical" when it apparently involves running a tube through your abdomen and into your stomach? Is this one of those things where a legal definition is totally at odds with common understanding of words?
posted by indubitable at 3:12 PM on June 16, 2016 [17 favorites]


So this is basically fistulation for people?
posted by chimaera at 3:15 PM on June 16, 2016 [7 favorites]


Metallica - Live Sh*t: Binge & Drain Through Your AspireAssist doesn't have the same ring to it.
posted by Existential Dread at 3:15 PM on June 16, 2016 [2 favorites]


"No, no. This isn't surgery. It's piercing. You have pierced ears, right? Would you call that surgery? Of course not! We're just gently piercing your skin, muscle tissue and various other thingies. And your stomach. That's not surgery."
posted by Splunge at 3:16 PM on June 16, 2016 [10 favorites]


Nope. Nope. Nope.
I want to get rid of some poundage, but that one isn't an option.
posted by BlueHorse at 3:17 PM on June 16, 2016 [1 favorite]


Paging Dr. Cronenburg, to the white courtesy phone...
posted by Cookiebastard at 3:22 PM on June 16, 2016 [22 favorites]


What's the infection risk?

This also seems sort of wasteful, vs. medical devices or procedures that make the user feel satiated with less food (stomach restriction): it's throwing the food away after you've eaten it, instead of dumping your plate, but ultimately the same thing.

I understand that for some dangerously obese people the problem is psychological, and so being able to drop weight without changing eating habits at all could be helpful, but doesn't that just lead to permanent dependance on the ability to remove food you've consumed before digestion? I guess even so it would still be a clear benefit to patients who have a chicken-and-egg problem in that they need weight loss to happen before they can usefully begin to make lasting behavioral changes.

I'm pretty sure this isn't going to be nearly as care-free and easy as the pitch makes it sound, though. My grandfather did at-home dialysis towards the end of his life. It was done using a button drain and an external pump, and it still severely restricted the freedom of his day-to-day life.

Eating isn't as immediate and critical a need as kidney function, but still.
posted by snuffleupagus at 3:23 PM on June 16, 2016 [1 favorite]


Competitive eaters hate this one weird trick!
posted by I-baLL at 3:25 PM on June 16, 2016 [23 favorites]


Oh my god, this is it, isn't it. This is the weird trick! It's weirder than we ever could have imagined.
posted by Mr.Encyclopedia at 3:27 PM on June 16, 2016 [131 favorites]


I can't wait for the AskMes about whether it is safe to eat the same meal twice.
posted by oulipian at 3:29 PM on June 16, 2016 [47 favorites]


Mrs. Wimp and I have been joking about creating such a device for over 20 years. It was a joke, people!
posted by Mental Wimp at 3:32 PM on June 16, 2016 [3 favorites]


Tim And Eric need to make the Cinco version of that video.
posted by sourwookie at 3:36 PM on June 16, 2016 [6 favorites]


Website doesn't scale down on mobile devices, page doesn't fill the screen and pictures won't load.

Clever!
posted by hal9k at 3:41 PM on June 16, 2016


I remember as a child being taught the excess of the Romans. Those decadent vomitoriums. Wow, we are way ahead of them.
posted by Abehammerb Lincoln at 3:43 PM on June 16, 2016 [14 favorites]


With the exception of a few activities such as deep-water diving, the AspireAssist will not limit normal physical activities, such as swimming or jogging.

Deep-water diving? but what could oh god no

Wish there was a good close-up picture of the exterior valve. I'd love to make a bunch of glue-on mockups for people who want to look hip.
posted by phooky at 3:44 PM on June 16, 2016 [2 favorites]


Ok, the jokes write themselves. And my first thought was seriously wtf. But then I thought, there are people so desperately unhappy and who feel so unable to lose weight that they will voluntarily get a tube in their stomach and...unshit? a third of their meals in the toilet to try and do something about it. And I can't feel anything but compassion because Christ almighty one way or another we are failing people if this is what it takes for them to get help.
posted by billiebee at 3:45 PM on June 16, 2016 [37 favorites]


How do they get to call it "non-surgical" when it apparently involves running a tube through your abdomen and into your stomach?

No surgery is involved at all!

You just put the container for the AspireAssist on your torso, and the razor-sharp teeth of the alimentary tube will automatically dig through your abdominal wall. The contact anesthetic will make sure even the most sensitive monkeyboys won't feel a thing.

Monkeyboys should ignore any implication that there are organic components to the AspireAssist. It will also never implant an egg. We have that quirk licked.
posted by happyroach at 3:47 PM on June 16, 2016 [29 favorites]


I just read the website, not the promotional material, so I don't know if this is fluff, but they said that the weight was kept off for a period of over 4 years. Which, given what I've read about diets and rebounding weight, sounds rather impressive. However, this was in a study with one on one counseling and other expensive help. So, sounds great if you can afford it and sounds like less of a risk than barriatric surgery. And less of a risk of shitting yourself in the middle of a meeting. On the other hand, it's gross, the seal will get degraded with time and it sounds like this is something that needs to be used for the rest of the patient's life. But hey, it's better than regulating sugar, right?
posted by Hactar at 3:51 PM on June 16, 2016 [3 favorites]


I remember as a child being taught the excess of the Romans. Those decadent vomitoriums.

Vomitoriums have nothing to do with food or puking.
posted by jedicus at 3:51 PM on June 16, 2016 [62 favorites]


Here's a 2009 review of gastrostomy tube-related complications. Highlight:
Peristomal wound infection is seen in up to 30% of cases[...] Accidental dislodgement of the PEG tube occurs in 1.6-4.4% of cases[...] Colonization of the PEG tube with fungus may lead to degradation of the tube. It is a long-term complication that is reported to cause up to 70% failure by 450 days[...] Diarrhea occurs in 10-20% of patients after PEG placement.
Now of course we place g-tubes in a different (usually sicker) patient population that may be more predisposed to the above complications, but patients who would get this therapy likely already have comorbid diabetes at the very least.

I doubt the efficacy of this device would hold up against that of roux-en-Y or sleeve procedures. The 12.1% total body weight reduction is nothing compared to the RY and sleeve procedures, and even lap band boasts a loss of 45% excess body weight reduction (admittedly this is apples/oranges but I don't have the time to do the conversion right now).
posted by The White Hat at 3:53 PM on June 16, 2016 [5 favorites]


I'm waiting for the kickstarter porthole version.
posted by srboisvert at 3:55 PM on June 16, 2016 [1 favorite]


Forget weight loss, I'm getting one of these so I can binge drink all day and night and never get too drunk!
posted by ejs at 3:55 PM on June 16, 2016 [6 favorites]


I'd be surprised if this actually worked as well as gastric bypass. Unlike caloric restriction by itself, gastric bypass actually causes changes in signaling, satiety, and glucose control (e.g.). It's one of the reasons it's so much more effective than dieting. Just siphoning out the extra calories without causing any structural changes seems like it wouldn't give those extra advantages.

Other sources I've seen refer to it as "minimally invasive"; idk why they're allowed to say "non-surgical" since it definitely involves, like, some cutting into your body cavity. I guess they're distinguishing it from gastric bypass surgery, which is certainly super invasive, but it still seems like a super odd way to phrase it. On the plus side, twilight anaesthesia is pretty fun -- propofol!
posted by en forme de poire at 4:08 PM on June 16, 2016 [9 favorites]


Forget weight loss, I'm getting one of these so I can binge drink all day and night and never get too drunk!

IANAD, but AFAIK alcohol is absorbed into the bloodstream via the stomach, so the, ah, exit point would need to be a little higher up the plumbing setup.
posted by mandolin conspiracy at 4:15 PM on June 16, 2016 [3 favorites]


Vomitoriums have nothing to do with food or puking.

Sweet! Thanks, jedicus! I love this place.
posted by Abehammerb Lincoln at 4:16 PM on June 16, 2016 [8 favorites]


IANAD, but AFAIK alcohol is absorbed into the bloodstream via the stomach

Some of it is, but most is absorbed in the small intestine when the stomach empties.
posted by jedicus at 4:19 PM on June 16, 2016 [1 favorite]


I can't wait for the AskMes about whether it is safe to eat the same meal twice.

I say try it and report back to us!
posted by Naberius at 4:29 PM on June 16, 2016 [1 favorite]


oulipian: "I can't wait for the AskMes about whether it is safe to eat the same meal twice."

The stomach acid mixed with the food would be really hard on teeth, mouth, and esophagus.
posted by Mitheral at 4:34 PM on June 16, 2016 [1 favorite]


I think it bears mentioning here that this sort of intervention is probably not intended to be used for the rest of your life. And "just eat less" is generally a viable strategy, yes. But if you have substantial weight to lose and you need to do so fairly quickly? The amount of calories you get allocated per day can quickly shrink to the point that they require inhuman levels of self-control to endure. I don't think this intended for "I need to lose a few pounds". This is the sort of thing that could be used to supplement a dietary plan for the sort of person who's being encouraged to live on 1000, 800, even 500 calories a day, which is a thing that does exist. This could be the difference for someone with a medical need to lose weight between being able to consume real food and having to live exclusively on prepared diet products.

My stepdad had bariatric surgery and has basically gained all the weight back again, but it's still had a permanent long-term impact on his ability to eat normal food with other people. I don't love the idea of this sort of thing, but I think one has to contrast the idea of the "wastefulness" of this with the fact that people who need to lose large amounts of weight are often expected to consume food in a way that bears absolutely no resemblance to the way humans normally interact with food, and they don't come out of it able to relate to food properly. This presents the idea that you could adopt a new way of eating that was intended to sustain you long-term, but just cut your actual absorbed calories sufficiently for the early months for weight loss. If people came out of this sort of medical treatment with a healthier relationship to how to eat for the long-term, that could substantially improve their lives, the lives of their kids and partners, and so on.

Which is not to say it'll necessarily be used like that, but--there's at least potential.
posted by Sequence at 5:02 PM on June 16, 2016 [16 favorites]


Accidental dislodgement of the PEG tube occurs in 1.6-4.4% of cases

It seems like a very present danger for a non-sedentary person. How does the tube adapt to your body's layers shifting and rolling? Especially if you already have a lot of layers and rolls, and you're trying to lose them by exercising, swimming, etc.? The skinport would be like a space elevator on top of a tube through the atmosphere.
posted by Countess Elena at 5:03 PM on June 16, 2016 [1 favorite]


Also, how do you remove the thing? Maybe you can install it with a piercing like technique but when you remove it there's going to be a nasty little peritonitis ready hole in your stomach. I don't think just sliding it out and hoping for the best is a practical way to deal with it.
posted by Bringer Tom at 5:25 PM on June 16, 2016


Can you save what you take out and eat it later?
posted by Napierzaza at 5:32 PM on June 16, 2016 [1 favorite]


Monkeyboys should ignore any implication that there are organic components to the AspireAssist. It will also never implant an egg. We have that quirk licked.
posted by happyroach


Epony...

Epony...

Epony...

Eponyhehhehahhahahaha!

*cell door closes ominously*
posted by GenjiandProust at 5:36 PM on June 16, 2016 [9 favorites]


en forme de poire: Just siphoning out the extra calories without causing any structural changes seems like it wouldn't give those extra advantages.

On the website, it says you have to learn to chew more slowly, so the food is mushy enough to get sucked back out. That gives the satiety signals more time to reach the brain, according to them. So the habit you learn to use the device properly helps you eat less over time.
posted by Kevin Street at 5:44 PM on June 16, 2016


The stomach acid mixed with the food would be really hard on teeth, mouth, and esophagus.

Definitely a plus for the accidentally-fused-with-fly-in-an-experimental-teleporter demographic, though. (Is Dr Cronenberg here yet? I thought someone paged him several comments ago.)
posted by No-sword at 6:10 PM on June 16, 2016 [1 favorite]


Also, the fact the tube clogs on big chunks of food is a feature. It encourages Fletcherism.

Marketing is amazing.
posted by mccarty.tim at 6:30 PM on June 16, 2016 [2 favorites]


The stomach acid mixed with the food would be really hard on teeth, mouth, and esophagus.

I predict an AskMe question of "What foods are so alkaline as to taste better the second time?"
posted by Dip Flash at 6:37 PM on June 16, 2016 [1 favorite]


Vomitoriums have nothing to do with food or puking.

dammit, Dad! more bullshit i have to unlearn.
posted by indubitable at 6:51 PM on June 16, 2016 [3 favorites]


So this is, like, medicalized bulimia? Great. Just great.
posted by xyzzy at 6:53 PM on June 16, 2016 [6 favorites]




Here's the FDA summary with lots of details.

Note that the control group received "Lifestyle Therapy" which did not include instructions on calorie restriction, so they probably ate the same number of calories as the folks having their stomachs pumped. But I kinda wonder if the therapy is just a recurring revenue stream (you have to go in to reset the device every 115 uses or it stops draining).
posted by RobotVoodooPower at 7:14 PM on June 16, 2016 [1 favorite]


Don't worry, Colbert's team has improved the design with the Esophagorge.
posted by maudlin at 7:58 PM on June 16, 2016


With a voice-over, this could be a commercial from Rick and Morty in an alternate universe.
Today on How To Lose Weight: Wumbuses. Everyone who wants to lose weight can keep a wumbus in their home. First, you take the doodlebeep, and you smooth it out with a blomp right through your crombop. (The shleem that results is repurposed for later uses in a small, square container called a crambap.) The doodlebeep, which has been pierced through the your grumbo, is where the floob is located. It's important that the floob button is pressed, because the floob has ALL of the floob juice. You can keep pushing the button to drain the floob juice. Before surgery, there are several dizzards in the way, but those can be displaced for during a 10 minute in-patient visit to your main Dorpher. When you are done, you are left a clean Wumbus, which you can put away for later use.
posted by SpacemanStix at 8:41 PM on June 16, 2016 [3 favorites]


Oh HELL to the NONONONONONO!

No fistulated cow video yet? You people disappoint me sometimes. Here.
posted by Trinity-Gehenna at 9:02 PM on June 16, 2016 [3 favorites]


This is gross and probably super dangerous, but I think the dissolvable balloons that take up space in your stomach are going to be super popular in a few years. Low cost, low risk, no surgery needed to put in or take out... I can imagine tens of millions of people getting them installed.
posted by miyabo at 9:04 PM on June 16, 2016 [1 favorite]


I think the dissolvable balloons that take up space in your stomach are going to be super popular in a few years.

Burritos are already pretty popular.
posted by RobotVoodooPower at 9:21 PM on June 16, 2016 [25 favorites]


Wow. As someone who's had issues with bulimia, this doesn't seem like a symptom of the ~decadent West~, it just sounds incredibly dangerous. I don't even want to know what a binge/purge episode would look like when perforated internal organs and perineum are a factor. Jesus christ.
posted by moonlight on vermont at 9:28 PM on June 16, 2016 [10 favorites]


Forget weight loss, I'm getting one of these so I can binge drink all day and night and never get too drunk!

Or just like hook it up to a bag o' wine under your shirt for a continuous Franzia drip feed, get that discreet day drunk on
posted by jason_steakums at 9:49 PM on June 16, 2016 [4 favorites]


they will voluntarily get a tube in their stomach and...unshit? a third of their meals

I would classify this as pre-shit, not unshit. Unshitting is a different One Weird Trick entirely.
posted by komara at 10:16 PM on June 16, 2016 [2 favorites]


My comment from the previous thread still applies. Marketers, call me!
posted by zippy at 10:51 PM on June 16, 2016


I mean, I'm a round middle aged lady. I would love to be a svelte middle aged lady, but genetics and disabilities make that difficult, but holy mother of all things edible, I'd rather buy plus size pants than have a drip tube that lets me pretend I didn't just eat a cupcake.
posted by SecretAgentSockpuppet at 11:00 PM on June 16, 2016 [11 favorites]


I guess it's less dangerous than the Breaking Bad Star Trek pie eating version.
posted by artychoke at 11:10 PM on June 16, 2016 [1 favorite]


I suppose after the apocalypse comes, parents could go out foraging for food among the roving gangs and zombies and come home to feed their hatchlings children through one of these.
posted by Slarty Bartfast at 11:12 PM on June 16, 2016


I'm kinda guessing this is not a product aimed at slightly overweight people who would just like to be a bit slimmer.
posted by Bugbread at 11:15 PM on June 16, 2016 [3 favorites]


The Romans didn't have anything on us.
posted by a lungful of dragon at 11:17 PM on June 16, 2016


"It's Tradition Days down by the Whately Family Sugar Shack! C'mon down and sample some of the best we have to offer. Ride our shoggoth drawn sleigh out to the Wailing Orchard and try some fresh tapped Human Syrup poured over fresh, cold ash from the Howling Rend in Reality. Look into the eyes of the screaming, writhing Syrup Sack and thank them for their sacrifice so that you may work in worship around the Black Ziggurat the rest of your scream-tormented existence. "
posted by robocop is bleeding at 3:46 AM on June 17, 2016 [10 favorites]


I am an ear, nose, and throat doctor. I placed a ton of percutaneous feeding tubes when I was in residency and seeing a lot of head and neck cancer patients. This device is just a fancy version of those tubes. I have some thoughts on this.

First, I don't consider this a "non-surgical" procedure. A hole is made in the skin, abdominal muscle, and stomach wall and a tube is passed through all of those structures. This is done under MAC anesthesia. That's surgical in my book.

Second, I think the website does a poor job or explaining the risks. While there are risks associated with all weight loss surgical procedures (banding, stapling, roux-en-y, etc), I feel like this is being marketed as a "simple alternative" to those. In most patients, it probably is, but the FDA only looked at 111 patients, which isn't a huge sample size. The most common problem with feeding tubes is necrosis of the skin under the tube site. Next is bacterial skin infection that is usually cased by Staph and can be severe enough to warrant admission to the hospital and treatment with long term IV antibiotics. I've seen patients with leakage of stomach contents from the tube site and resultant peritonitis, a potentially life-threatening infection of the abdominal cavity. There were patients at my institution who died from feeding tube complications.

Finally, the practitioners performing this procedure (initially GI medicine doctors, soon followed by plastic surgeons I'm sure) will not be able to take care of these complications. Tube dislodgement often requires an open operation to repair the hole in the stomach. The GI surgeons are going to get really pissed about this, really fast.

This is an interesting alternative to other weight loss solutions and I'm sure some patients will love it. But I hope that those performing the procedure will be very careful explaining the risks versus the benefits.
posted by Fritzle at 5:30 AM on June 17, 2016 [23 favorites]


Trying to imagine Third World reaction: "you mean you eat so much you have a device to dump some of it?"
posted by MrGuilt at 5:40 AM on June 17, 2016 [2 favorites]


i am worried about you, robocop is bleeding

but i am also going to favorite your comment
posted by indubitable at 5:45 AM on June 17, 2016 [2 favorites]


Forget weight loss, I'm getting one of these so I can binge drink all day and night and never get too drunk!

Think of the savings: chug a few drinks, and then just run a straw up from the drain tube to your mouth and keep it cycling in a loop until you have extracted all the alcohol. No more wastage!
posted by Dip Flash at 5:57 AM on June 17, 2016 [1 favorite]


i am worried about you, robocop is bleeding


RiB did gloss over the obvious solution -- implant a piece of proto-shoggoth material in the patient! The seedbud will absorb the excess nutrients and induce weightloss. As long as the seedbud was harvested from a progenitor built around MNaR 3.02 or later, the implantation should be controllable via wireless or hypnotic domination. Once a patient dies, of course, the body will soon form a neutrient bed for a juvenile shoggoth, which will emerge eager to shout and kill and revel in joy, but this is generally a bonus for our special clientele.
posted by GenjiandProust at 6:15 AM on June 17, 2016 [1 favorite]


You know, as mammals, we are already equipped with a device that will remove calories right from your blood stream and export them in concentrated form. In fact, two devices. Why not just stimulate milk production and pump away all the extra calories you like?
posted by 445supermag at 6:40 AM on June 17, 2016 [5 favorites]


Because that would be weird.
posted by Slarty Bartfast at 6:46 AM on June 17, 2016 [5 favorites]


Re: Tim & Eric in the FPP:
This one is also appropriate.
posted by LiteS at 6:53 AM on June 17, 2016 [3 favorites]


The stomach acid mixed with the food would be really hard on teeth, mouth, and esophagus.

This would not stand in the way of hipsters attempting some to popularize sort of molecular-gastronomy-meets-Cronenberg-body-horror cuisine.
posted by mandolin conspiracy at 7:10 AM on June 17, 2016


On the website, it says you have to learn to chew more slowly, so the food is mushy enough to get sucked back out. That gives the satiety signals more time to reach the brain, according to them. So the habit you learn to use the device properly helps you eat less over time.

This could probably be effected without the gut-cutting. But I imagine that committing to the procedure functions as a strong motivation to actually follow through with it consistently. Quite the placebo, if that's part of it.

I remember hearing about a (truly non-invasive) feedback machine that helps people pace their eating (I think in this doc).

[Googled, came back]

It is called a Mandometer, and it's used as part of what looks to be a very comprehensive treatment for people with various eating disorders (binge eating, anorexia, bulimia) to help them understand and regulate their signals and consumption. No cutting.

Explanation, from one study:

Apparatus and experimental manipulation of the speed of eating

Mandometer® is a weighting scale and a custom-made computer with a 15 in. touch screen (Mikrodidakt AB, Lund, Sweden). The computer stores the weight loss data generated when a subject eats food from a plate placed on the scale and the cumulative food intake is modelled by: y = kx2 + lx, where the k-coefficient reflects the change in eating speed over time, i.e., the degree of deceleration of the eating rate over the course of the meal, and the l-coefficient reflects the initial speed of eating [2].

Once the curve of the cumulative food intake has been determined for an individual, her or his eating behaviour can be experimentally modified. This is achieved by programming the computer with the amount of food to be consumed and the duration of the meal; the software calculates the k- and l-coefficients, and the corresponding cumulative intake curve can be displayed on the computer screen. Such experimentally changed curves are used as feedback guiding the individual to eat in a predetermined manner. For the purpose of testing the present hypothesis that a change in the speed of eating affects food intake, the cumulative curve of food intake that each individual student generated when eating individually in unrestricted conditions was displayed on the computer screen, but the duration of the meal was shortened or prolonged (see below). The subject can adjust her/his speed of eating to these feedback curves because her/his own speed of eating emerges on the computer screen during the meal and can therefore be compared to the reference, feedback curve.

The subject estimates her/his feeling of fullness (satiety) from nothing at all (0) to maximal (10) on a scale, which also appears on the computer screen during the meal. Similar methods have been used before [12, 13, 14], Mandometer® adds the possibility of experimentally controlling food intake [2, 4]. A brief video shows how it works [15].

posted by cotton dress sock at 9:36 AM on June 17, 2016


Oo, now the vomitorium comes to you!
posted by lubujackson at 10:03 AM on June 17, 2016


Reminds me of the Crosswell Tape artificial tapeworm from "Supertoys Last All Summer Long" by Brian Aldiss.
posted by domo at 1:00 PM on June 17, 2016


Reading about this device has made me lose my appetite.

Maybe that’s its secret.
posted by Fongotskilernie at 8:12 PM on June 17, 2016


One of the saddest things I've read recently was an acquaintance who posted that she went to Mexico for weight loss surgery and since then has spent the intervening months wishing she were dead. But she'd lost 60 lbs. And the comments were nothing but congratulations.

I had a close friend who had bariatric surgery when it was new and had severe complications. She lost so much muscle mass due to not being able to get adequate nutrition that she was in a wheel chair. The change in her from a joyful large person who was full of life to someone who looked like all her life-force was sapped out of her was heart-breaking.
posted by threeturtles at 8:46 PM on June 17, 2016 [3 favorites]


I recently went to a lecture given by a bariatric surgeon, and I thought I'd share some of the data from that lecture. Obviously the lecturer is likely to be biased in favor of bariatric operations, but he does work on the NHS so at-least he's not paid fee for service.

Anticipated Weight Loss (percent of excess weight):
GP supervision: 0%
Commercial programmes: 5%
Multicomponent intervention: 5-10%
Medical therapy: 5%
Bariatric surgery: 50%

Its worth noting that bariatric surgery, particularly a Roux-en-Y procedure, seems to be effective in preventing and reversing type 2 diabetes beyond their effect on body weight.

The NHS will pay for bariatric surgery in the following circumstances:

BMI >40 or BMI >35 with comorbidity (Diabetes, Obstructive Sleep Apnoea) - In those who have tried non-surgical measures for 6 months without success, and are fit for surgery

In those with BMI > 30 and recent onset diabetes, surgery is also offered

posted by DrRotcod at 2:52 AM on June 18, 2016 [1 favorite]


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