It Was A Boardwalk Moment...
Even with the enormous potential of sensory overload down at the Boardwalk, I had some thinking time to myself this Summer on Vacation while drifting in the sea of people and epicurean delights.
How many of these people here qualify (or are actively working on it~ ) for Bariatric Surgery?
How many of these people are Diabetic, or will be in the near future? How many actually would be diagnosed with Type II DM, with a random glucose of >200 mg/dl, right now?
And how many of their PCP's have thought of, or discussed with their individual patient, the possibility of greatly improving (and possibly “resolving”) their disease - with all its attendant meds, insulin injections, finger sticks, constant vigil of monitoring of eating-activity-illness, office visits, specialist visits, co-pays, not to mention all the co-morbid conditions that are associated so intimately with the disease when not controlled optimally?
I somewhat reflexively asked myself all those questions because I am all too familiar with many aspects of this dilemma (and No, I did NOT have Bariatric surgery, despite my BMI of 25.1):
*I am a Physician Assistant at a high volume Bariatric Care Center, where we are a Center of Excellence in Bariatric Surgery, and I see these stories come to life every day at work in the office, hospital, and OR.
*I have worked in Primary Care, with 10 years experience at a wonderful office, Scotia Glenville Family Medicine, and saw many Diabetics, as well as encouraged (often in vain) the lifestyle modification needed, along with pharmacological support as necessary, to get control of their disease. Weight loss? Yeah, we talked about that a lot, and I honestly didn't often see any great reductions that lasted...
*I have spoken with a number of my PCP colleagues (MDs, DOs, PAs, and NPs), and most do enjoy the benefit of a successful patient that they have referred to us, but there seems to still be a a lot of mystique about the whole “Bariatric Surgery Thing”, i.e. Who to refer for which procedure, When to refer, How well each surgery works in our experience, Complications, who Manages what after surgery, etc.
I can easily put myself in your place, and realize the quandary you may find yourselves in. Initiating or allowing a patient to go for a procedure you may not be totally comfortable with, even though they may have few remaining options, is tough. Bariatric surgery is NOT for everyone; it's usually a last resort kind of thing. Heck, bringing up the fact to a patient that they are “Morbidly Obese” is often a bombshell enough!
*And lastly, although I do not have T2DM, I do have Type 1 DM, and have had it for almost 30 years now. So I do consider these folks fellow disease-companions, but I must admit that I am a bit jealous of the fact that for the vast majority of them, if they (in general terms) can manage their lifestyle a little better with maintained weight loss and appropriate dietary choices and portions, they could be disease-free.
I don't have that option... Still much easier said than done, I know... so here we find ourselves.
So there you have it. And now for the next part of the Blog- the “Doing” of it. My aim is to post 2-3 times a week and see how it evolves. Please help me by interacting to keep this pragmatic and relatable.
Lastly, I am honestly not a big fan of Blogs, if fact I only browse onto one every now and then. I just thought this would be the best way, in these Social Media times, to get the message out there. I suspect that this will meander along the path I intended from the start (A Blog about Diabetes Remission / Resolution and Bariatric Surgery), but then take on a reactive dynamic that can hopefully make y'all out there in Primary Care a little more comfortable with all the “Bariatric Surgery Thing”. I will give you a look inside what we do in Bariatric Surgery, how we can help you to help your patients best, along with representative patient scenarios (HIPPA -friendly, of course!). My hope is that this will also provide a way for us to communicate more directly in a way that will help more and more Providers as time goes by.
That's the plan at least, so let's get to it... bet you can't read just one entry...
