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| From HowStuffWorks / TLC |
So, amid the day's scheduled (and unscheduled) patient visits, I saw in follow up a Diabetic patient, or should I say 'formerly Diabetic', who was 1 mos S/P a Sleeve Gastrectomy.
She relayed a tale of her pursuit of Bariatric Surgery despite a number of obstacles. Apparently her Primary MD initially put her off for a few weeks.
Then when she asked the other MD in her practice to consent to her having surgery, he replied, "That is the worst thing you can do. A patient like you with not much can lose can do it easily with exercise and diet, and you DON'T need surgery." She went back to the first MD she saw in the practice, and she consented to her having a Bypass.
Bringing her to the necessity that surgery was what she needed was the fact that for her, the next step in her DM Rx was insulin. She said "No way; Not me".
She was further emboldened by experiences in her own family. She has an overweight sibling with DM2 on an insulin pump, and another sibling with DM2 with pancreatitis and obesity who awaits a different type of intestinal bypass procedure, along with a partial pancreatectomy and pseudocyst drainage. She has extended family that are all suffering with the disease and its complications.
I asked her where she got her information about the metabolic benefits of weight loss surgery, and she replied "Dr. Oz, of course!"
Demographics: 52 y/o WF
Start Weight: 226 BMI: 36
Date of Surgery: 12/12 Gastric Bypass
DM Hx: She presented to us on Metformin 1000 BID, Glyburide 25 BID, and destined for insulin after maxing out on medical therapy. She had attempted to lose weight at onset of her Diabetes, and repeated her attempts thereafter at non-surgical weight loss, unfortunately to no durable avail. Duration of Diabetes diagnosis was about 4 years.
Current DM Hx: She is now 1 mos post op from her Sleeve, and off antidiabetic agents since the time of her surgery as she recovered in the hospital for one day post op. She still tests her BGs at home on occasion, but less and less now that her post op high has been 118, and she often is less than 100 mg/dl before meals. She is understandably ecstatic with her "non-diabetic" status now, and also further encouraged by her current weight of 189 / BMI 30 when seen today.
Take Home Point: The information revolution claims another victory. Patients are more informed now than ever, although not necessarily properly informed, and certainly not just about this issue of Diabetes and obesity.
As you know, they commonly will question you about your antibiotic choice, or suggest a differential diagnosis that may either be thought-provoking, or a true zebra- but it's all in play now. I have heard that Dr. Oz had a series of programs on obesity, surgery, and Diabetes Rx, and was well-received by the media and patients alike.
Having surgery for this patient was, and will be, a win-win for her and the MD as it plays out in terms of long-term health and her DM remission, and likely resolution (I do not know her C-Peptide to even comment on that one).
As I have stated earlier, and it still remains an absolute truth: Surgery is not for everyone. It may be clinically indicated for many, and even very likely to be significantly life-altering (in a positive way) for a good proportion of those, but timing and patient "buy in" is everything. The degree that behavior dictates both short and long term efficacy of the procedure mandates this.
And you, as PCPs, are the best to decide if someone is ready, willing, and medically able to take that next step, and likely to be a winner in the 'risk vs. benefit' arena.
But, be on guard. Your patient may pop the question before you do, and will be expecting an informative, compassionate response in reply.
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