DEAR DR. DONOHUE: I come from a family of “full-bodied” people. My father and mother both died in their early 60s. They were overweight. All my life I have been overweight. I currently weigh 250 pounds and am 5 feet 5 inches tall. I have just developed diabetes, and I am scared. You name the diet, and I have tried it. I might lose 10 pounds, but I gain it back after I stop dieting. My husband and my two children are overweight. I want to set an example for them. I’m considering weight-loss surgery. What do you think of it? — C.M.

ANSWER: I think weight-reduction surgery — bariatric surgery — is a justified consideration for someone like you, someone who has tried to lose weight, who has a complication of obesity (diabetes) and who has a family history of death at relatively early ages.

You have a body mass index of 41.4. Body mass index is a better approximation of how much weight is fat than is weight from a scale. BMI is obtained by dividing weight in pounds by height in inches squared and then multiplying the result by 703. A BMI of 41.5 indicates severe obesity. For you, weight-reduction surgery could be lifesaving.

No surgery should be jumped into without awareness of its possible complications. One kind of weight-loss surgery is “restrictive” surgery. The stomach is made smaller. Another kind of weight-loss surgery is “malabsorption” surgery. Part of the small intestine, the site for calorie absorption, is bypassed. And a third surgery combines elements of both these other two. Each procedure has its pros and cons. You have to discuss with the surgeon which is best for you.

A mortality of less than 1 percent at one month post operation is cited for this kind of surgery. A surgeon experienced in all the techniques available will have an even lower mortality rate. Choose a surgeon with care, one recommended by your family doctor.

DEAR DR. DONOHUE: My wife and I are senior citizens who have heard from friends that the flu shot to be given this year is actually a combination of West Nile virus vaccine and the flu vaccine. We were told that the combined shot has made quite a few people sick. We were advised not to get it.

What is your advice on this? — T.M.

ANSWER: Whoever told you that is either misinformed or is pulling your leg. The West Nile virus is not included in the flu vaccine.

I haven’t seen or heard of any more reactions from this year’s flu vaccine than has happened in the past. Most reactions are a bit of swelling and redness at the site of injection. A very few people develop a slight temperature and feel out of sorts for a day or two. Even these minor reactions occur infrequently and ought not to scare you from having the shot.

DEAR DR. DONOHUE: If I drink ice water quickly or hold anything cold in my mouth for a little longer than usual, I get a piercing pain in the middle of my forehead. I’ve reacted like this for my whole life, and I am 64. I can’t believe this is anything bad, but I’d like to know what it is. — B.W.

ANSWER: That pain is called an ice-cream or ice-pick headache. It’s exactly as you describe, a transient pain in the middle of the forehead. One explanation is the cold material in the mouth constricts an artery supplying blood to the forehead. The constriction is as fleeting as is the pain. It’s not an indication of anything bad.

DEAR DR. DONOHUE: Should people suppress a sneeze? My mother taught me to do so, and I have told my children to do the same. My 13-year-old daughter, who knows everything about everything, says it’s unhealthy. She didn’t say why. Is it? — L.G.

ANSWER: If a person tries to completely squelch a sneeze, bacteria and viruses can be forced into the middle ear. A tube connects the throat and middle ear.

It’s OK, however, to tone down a sneeze.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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