LUCY SCHULTZE

His patients might have struggled to resist snacks and sweets, but at least their potential breakthrough won’t be sugar-coated.

Giving prospective bariatric patients an unflinching look at the pros and cons of the procedure is integral to the practice of Dr. David Tichansky and his partner, Dr. Atul Madan. As co-directors of the bariatric program for UT Medical Group, they hold a free educational seminar every six weeks or so at the Germantown Multispecialty Clinic on Wolf River Boulevard, where they encourage people to exhaust all their options to lose weight before thinking about surgery.

“Something we both believe in is to be very forthright about surgery—what you can expect, what it’s been shown to do and also what the risks are,” Tichansky said.

“It’s very intricate and difficult surgery, and while almost everybody does well, there are a few who don’t and there’s a very small risk of dying,” he pointed out. “Some people think we’re too blunt. But I would want to know it all, and I always want to treat people the way I’d like to be treated.”

Offering obese patients a chance to start fresh after many years of struggling to control their weight has proved a rewarding career for Tichansky, who joined UT Medical Group in 2004.

He happened upon the specialty more as a matter of timing than intentional choice. Minimally invasive forms of bariatric surgery were just being introduced during Tichansky’s laparoscopic-surgery fellowship at the Medical College of Virginia in 2002-03.

Today, bariatrics makes up about 80 percent of his laparoscopic surgery practice, including LAP-Band ® and gastric bypass.

“It’s sometimes a difficult practice, because there’s so much more need than you can possibly serve—especially in the South,” he said. “But for the people who are able to get through the whole process, it’s very rewarding. Every week, I see these people come in and they’ll be 75 or 100 pounds lighter. They came to me taking four or five different medications, and I have them down to one or none. They start taking vacations and doing things they couldn’t do before, when they had a very limited lifestyle because of their weight.”

Alongside his position in the private-practice arm of the University of Tennessee Health Science Center, Tichansky serves as an assistant professor in the medical school’s Department of Surgery and as co-program director of the Minimally Invasive Surgery Fellowship. He is also on active staff at the VA Medical Center, Regional Medical Center, Methodist University Hospital and Methodist Healthcare System.

While clinical duties make up the bulk of his work, Tichansky spends about a quarter of his time in his academic role, doing research and teaching residents and fellows.

It was the appeal of an academic environment that helped draw him to Memphis after working in private practice in his home state of New Jersey.

“Coming here is one of those things we look back on and say, ‘Yeah, that was a great decision,’” said Tichansky, who with wife Bobbi has two young sons.

“We’ve really enjoyed being parents in Memphis,” he said. “We’ve enjoyed taking advantage of the town—the zoo or Mud Island, the children’s museum and the Pink Palace.”

Spending time with his family and introducing his sons to outdoor activities like fishing and cycling is how Tichansky prefers to spend his off-work hours. As his sons get older, he hopes to share with them a love for sailing and windsurfing that he forged while living in the Northeast.

Growing up just outside Manhattan, Tichansky stayed close to home as he began his higher education studying mechanical engineering at Lafayette College in Easton, Pa. He soon steered away from that field and toward medical school, but gave his naturally mechanical mind a new application by pursuing a career in surgery.

After receiving his medical degree at New Jersey Medical School in Newark in 1996, he spent his general surgery residency and internship at Thomas Jefferson University Hospital in Philadelphia, including one year as a surgical oncology research fellow.

Today he is a board-certified surgeon and the author of many peer-reviewed articles, abstracts and book chapters on improving the techniques and safety of the minimally invasive surgical treatment of morbid obesity. He also applies minimally invasive techniques to the surgical treatment of colorectal cancer, gastroesophageal reflux disease, hernias and other abdominal problems. With Madan, he successfully performed the first laparoscopic gastric bypass on a liver-transplant patient.

Tichansky sees the introduction of laparoscopy to bariatric surgery as a key recent development in his chief specialty area.

“That was one of the best things that happened to weight-loss surgery,” he said. “With the big incisions, there’s a much higher incidence of getting an infection or hernias in the wound. But among the patients we see now, most go home in two days — or just one with a LAP-Band procedure.”

Still, he said, those physicians who still think of bariatric surgery in terms of big incisions and a high mortality risk are the chief source of continued controversy about the procedures.

“The way surgeons are looking at it now, the best analogy is to smoking and lung cancer,” he said. “If you don’t smoke, you’re probably not going to get lung cancer. And if you don’t overeat, you’re probably not going to get obese.

“But even for people who smoke three packs a day and get lung cancer, you still operate on them and try to help them. And I think that’s how a lot of people are looking at gastric bypass as well.”

Over the past five to 10 years, the national network of physicians performing the procedures has grown more connected, helping to standardize procedures and improve upon them by being able to directly compare results.

Among other developments in recent years, bariatric surgery has come more to the forefront of public discussion with several celebrities having the procedures. Although that discussion has revealed both good and bad results, it’s at least helped to get people talking about obesity in America, Tichansky said.

“Before the time I got into the field, it seemed like it was an individual person’s problem,” he said. “Today we’re starting to realize that it is a national problem—and it’s going to break our healthcare system if we don’t fix it.”



September 2007