Tuesday, October 22, 2013

Exhibit J: Ted's Red Chair in Fenway

Photo by M Clock


I was lucky enough to get to a raucous playoff win for the Red Sox a couple of weekends ago.  We were able to get in early enough to take a look around and watch some BP on a beautifully warm October twilight, with just a subtle suggestion of Fall in the air.

I was able to go and see the infamous Red Chair that sets itself apart in an otherwise uniform sea of green seats in the RF bleachers.  Some of you, I am sure, have seen it and are aware of it's significance.  That seat marks the landing spot of the longest HR hit at Fenway park - 502 feet - by Mr. Ted Williams, many years ago.

I thought of that chair when I saw a post op Bypass patient in followup this week, and her 'smashing' success is worth mention here as one of our metabolic case studies.

Demographics:  45 y/o F

Start Weight:  267 lbs  BMI:  42.9

Date of Surgery:  3/13  Gastric Bypass

DM 2 History:  She said her Diabetes began when she was pregnant with her first child in '93.  She was diet controlled, and remitted after delivery.  She retained some of her "baby weight", then gained some more, and by '95 she had elevated sugars again, this time in the absence of pregnancy.  Her blood sugar control was fair to poor since that time, and she saw an endocrinologist, and despite persistent additions and alterations to her med list she came to us with an A1C over 10.  Her med list she held in hand as she came for her initial visit:

Lantus 95 units bid, Humalog 20 units at meal time, Metformin 1 G bid, and Januvia

Other comorbidities are h/o MI, Dyslipidemia, and HTN.

Current DM History:  She is ecstatic about her newfound control on a much simpler regimen with Lantus 20 units daily, and scaled Humalog up to 10 units  pre-meals.  Her most recent A1C was 7.2 and she was enjoying eating again, with controlled portions and getting in sync with her sugars, diet, meds, and activities / exercise.  In the past she related that no matter what she did, 'even without eating', her sugars were elevated and uncontrollable. She is very happy she initiated the referral to our Center, and had a relatively easy time getting her PCP and Endocrinologist to endorse her to us.  She has lost 60 lbs to date, and is also off her BP med.

Take Home Points:  Standing (or sitting in the case of Ted William's chair) out in the crowd is usually a good thing.  With the crowd of folks with obesity and its associated metabolic diseases out there these days, it remains unusual for someone to take charge of their health situation, such as this patient has, have surgery, and follow through to see the dramatic benefit that bariatric surgery can offer.

As I have stated many times earlier, having the patients come to us as early as possible, once they qualify for surgery BMI-wise, and have failed more conservative approaches (lifestyle, weight loss, meds, specialty care), will ensure the best possible result for them in terms of preserving pancreatic function, lessening the chance of end-stage complications from their DM, and getting them successfully off meds for glycemic control, and more likely keeping them off them.

As you can see here, we didn't get to this patient all that early in her Diabetes disease process, yet a marked improvement in her Diabetes, and therefore both her short and long term health, has been realized.

And I still can't say it enough...Earlier is better.  Earlier is better. Earlier is better.

Unless it's shaving we speak of, then better to wait...  Go Sox!






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