Exhibit K: Age Limits vs. Term Limits (Part 1)

From Finra.org

Age can be limiting factor for many things, both via legal mandate, or by the progressive experience of bodily function diminishing or lost.

The opposite may also be true of aging, such as with the accumulation of wisdom, a valuable asset that increases in proportion to age.

(I would venture a guess that the negative effects of advancing age are easier to tabulate than the positive when it comes to aging, but that's just a guess.)

Furthermore, certain events in life occur at an arbitrarily set time and circumstance, as depicted in the image on the right.

Other, often more subtle effects of the aging process, occur progressively and can have just as a defining outcome when it comes to bodily function, physiology, cognition, and physical function. Frequently the additive effects of time can be unforgiving based on genetics, behavior and preexisting medical conditions.

Now, how about  Term Limits for a politician? I suspect that would bring about some well-needed change....

Where am I going with this? Good Question.

Another "Exhibit" whereby I describe a clinical presentation of an actual patient, and some real-time results, illustrating a new wrinkle in the daily care of our Bariatric patients.

In this presentation, from a patient I saw in the office last week, we will see the effect of surgery in a patient of moderately advanced age.  Interesting enough, I had a conversation about this very subject with a local Cardiologist who wanted to refer a patient to us, but was concerned that the patient in question was in her 60s.

Well, check this out.


Demographics:  73 y/o WF

Start Weight:  238   BMI 42

Date of Surgery:  1/28/14

DM2 History:  Longstanding h/o Diabetes, albeit "borderline", and on no anti-diabetic medicines. Her Glyco on our initial labs showed 6.5. She was concerned about the long term effects of her Diabetes, and whether or not it would lead to medicines and/or Insulin, or rapidly deteriorating health.

Other comorbidites were HTN (on 3 medicines), Hyperlipidemia (on a statin), and OA pain to her lower extremity joints, GERD on a PPI,  as well as Hypovitaminosis D.

Current DM2 and Post op Changes:  I saw her recently at her 6 mos post op check and she was 'Beaming' on the outside, but it came from the inside.  She said she felt wonderful with her new weight of 159, BMI of 28, and had a new found energy and zest for life.  Her BP meds were reduced to just one, and her BGs had been stable since surgery, to the point that she rarely checked them anymore.  She was incorporating a new level of exercise to her life, and her ADLs were getting easier and more enjoyable with much less OA pain.  She had taken to her new post op Bariatric diet, and was exploring new foods and optimizing her dietary intake calorically for protein and limited CHO.

Wow. Not a bad body of work for 6 mos post op.

Take Home Points: The more I have thought about this part of this Case Report, I have a number of related points that will make this THP section a little long to read.  I intend to neaten it up a bit by making this a Part 1 of 2 to go into these issues in a little more detail.

Additional related points of discussion I need to review revolve around the idea of risk vs. benefit in this population of more advanced age, and our standards as far as preop workup.  I want to briefly mention the position of most insurance companies when it comes to age and bariatric Surgery. And a few other salient points. So look out for that in Part 2 coming very soon!

In any event, in conclusion for this part, there seems to be no limited 'Term Limit' on the ability of the human body to bounce back from the effects of increasing weight-related comorbidity even with advancing age.

I believe I characterize our group's feeling well, by stating that age is a relative factor, and not an absolute factor, in considering the overall fitness / risk for surgery, especially in light the potential gains (as described here) that can knowingly be appreciated in the context of that relative surgical risk.

I would assume that Orthopedic Surgeons (total joints) and Cardiothoracic Surgeons (CABG, Valve Replacements, etc.) do the same, yet are met with far less less scrutiny than Bariatric Surgeons are, seemingly in the same regard. Is that fair?

Part 2 coming up next......