Exhibit C: A Walk on the Beach

                                                                  Photo by M Clock

Time to take a walk in the shoes of a patient I recently saw in the office in followup. We'll review the case, and I'll talk about an important aspect of practical risk assessment for a complicated patient such as this.

Demographic:  63 y/o Male

Starting Weight: 365  BMI: 59

Date of Surgery:  10/09  Gastric Bypass

Diabetes Hx:  Moderate disease, duration since 2006, generally well controlled on Metformin 500 BID

Co-Morbid Conditions: OSA, O2 Dependent COPD, ASHD s/p MI and CABG, Hyperlipidemia

Current State of Health:  Weight of 256 / BMI of 41. 

Resolved OSA, off CPAP. Off O2, COPD stable.  ASHD stable per Cardiology. Normal glycohemoglobins, off Metformin per his PCP.

Take Home Point:  Diabetes, especially of somewhat recent onset and under control with entry-level PO med and dose, was not this patient's biggest concern.  

Given his age, his severe mix of co-morbid conditions, and his associated self-admitted poor (and deteriorating) quality of life, aggressive weight loss via surgery was really the only potential path toward rapid improvement for this patient's health  at this time.  His PCP had been discussing this with him on multiple prior visits, and strongly encouraged him to contact us to get the process going soon.  His Cardiologist was on board as well, noting increased CV risk of surgery, but acceptable from a risk-benefit ratio perspective.

He certainly feels well now, very excited about his "turning back the clock" back to healthier and more active times.  Down over 100#, with regressed / controlled / resolved co-morbidities, and more than willing to talk at length to anyone that will listen about his story!  I had a hard time getting to see the next patient, but I needed to hear his story that day, so it was mutually beneficial.

Interesting from the medical standpoint, this is the type of patient anyone would agree would dramatically benefit from a successful weight loss surgery... but how many of you would feel comfortable initiating a referral for someone who appears to be at such high risk?  Is it fair to include in the risk assessment what will likely be the near future endpoint of this patient should he not lose weight aggressively?  

His PCP did, and the last comment the patient made before he left his most recent office visit was one we happily hear often at the Bariatric Center. "I wish I would have done this years earlier!"