Bariatric Surgery: Lindsey G's Story - CECity

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Table. Prescription Medication RegimenMedication—albuterol sulfate—allopurinol sodium 300 mg—alprazolam 0.5 mg—citalopram hydrobromide—cyclobenzaprine hydrochloride—glyburide—insulin glargine—insulin lispro—lisinopril—metoprolol tartrate—oxycodone hydrochloride—pregabalin—simvastatinDosage/Administrationas necessaryorally once dailyorally twice daily as necessary20 mg orally once daily10 mg orally 3 times daily as necessary5 mg orally once daily40 U subcutaneously once daily at bedtime100 U/mL subcutaneously on sliding scale(used briefly postoperatively)10 mg orally once daily100 mg orally twice daily5 mg orally every 6 hours as necessary(used briefly postoperatively)50 mg orally once daily40 mg orally once daily at bedtimeLindsey’s goal was—and still is—todefeat her son at a game of 1-on-1 basketball.Bariatric surgery resultsBefore undergoing bariatric surgery,Lindsey required insulin to maintain herblood glucose level, and her glycosylatedhemoglobin (HbA1c) level was 6.4%. Afterthe surgery she was able to discontinueinsulin and maintain her blood glucose andHbA1c levels by taking only metformin500 mg orally twice daily. With further diet,exercise, and weight loss, no medicationswere needed for these purposes by November2011. At this time, her HbA1c level was5.7%, and her pre- and postprandialglucose levels stayed in the range of 86 to90 mg/dL with diet and exercise alone.Lindsey’s positive experience isconfirmed by the literature, which suggeststhat most patients have greatly improvedglucose control after bariatric surgery. Insome cases, patients may even experience,someone else, because it won’t work. I knewI needed to do it when I hit my top weightof 479 pounds a year before the surgery. Igot down to 417 pounds before the surgery.I took a year to improve myself and doexactly what I needed to do, eat the rightportion size. You have to be committed todo your part. You have to love yourself first.If you are not doing it to better yourself,then why do it?Lindsey summarized her no. 1 reasonfor undergoing the surgery: “My goal wasto get off the medications. I was tired of somany pills each day. The weight loss partwas important too, but not the biggestissue.”The process is easier if patients havesupport at home. For Lindsey, her family isher support system, as she explained:My husband told me that he would loveme no matter what size I am, but that hewould support me to lose weight becausethat is what I wanted to do. My husbandand son both support me so much. It is ahousehold effort. We eat at home insteadof going out, eat healthy portion sizes byusing saucers, and we exercise together.My son is like my coach. We are allgetting healthy together.22 AOA Health Watch DOs Against DIABETES May 2012
as Lindsey did, a “cure,” with more than50% of patients who had diabetes mellitusno longer having diabetes symptoms. 6Other parameters that have shownimprovement after bariatric surgery includelipid levels and blood pressure levels. Morethan 50% of postsurgery patients no longerrequire medication to manage their hypertensionor are able to reduce their doses ofantihypertensive medication. 8“My goal was to get off themedications. I was tired ofso many pills each day.”—Lindsey G.Lindsey was able to discontinue use ofsimvastatin and to maintain adequatecholesterol control with diet and exercisealone, which was reflective of her decreasedweight. In March 2010, Lindsey’s bloodpressure was 142/82 mm Hg while takingmetoprolol 100 mg twice daily andlisinopril 10 mg daily. In November 2011,her blood pressure was 126/74 mm Hgdespite discontinuation of these 2 anti -hypertensive medications. As with lipids,blood pressure improves following loss ofweight, and in November 2011, Lindsey’sweight was down to 296 pounds.Lindsey is no longer taking any anti -depressant or antianxiety medications, andshe states that she is “doing great, and Iknow I can always go back to my counselorif I start feeling bad again.” In addition, herfood-purging behavior is absent. Some ofher improved mood may be attributed toimproved self-image, and Lindsey statesthat she is no longer uncomfortable beingin public—which had been a problem forher before surgery.When asked what she had wanted fromthe surgery, Lindsey answered as follows:I wanted to do all the things I was afraid todo because of my weight. I wanted to runand ride a bike with my son, to go toWorlds of Fun [a local amusement park]with my son and actually ride on a ride, andI wanted to not have to buy 2 seats formyself on an airplane anymore.Obese patients may give up social eventsand isolate themselves, vastly decreasingtheir quality of life. With her weight loss,Lindsey was able to go out and enjoy previouslypleasurable activities again.At the time the present article was beingwritten, Lindsey said she was lookingforward to a follow-up sleep evaluation todetermine if she still had OSA. She waseager to discontinue her use of the CPAPmachine, which is bulky and uncomfort -able. Studies show that approximately halfof obese patients experience a form of sleepdisturbance. After weight-loss surgery,there is a substantial decrease in the prevalenceof patients with sleep apnea, snoring,and sleep deprivation. 8 Lindsey also reportsno episodes of gout since having undergonebariatric surgery.Diet and exerciseWhen asked to describe her current diet,Lindsey responded as follows:I really don’t eat very much, because I amjust not hungry like I used to be. I eathealthy small portions and use a saucerinstead of a plate. When I used to fix aplate, it was a portion for 3 people. A saucerholds one serving size. I don’t eat bread. Idon’t drink anything 2 hours before eatingso that I am not full from liquids beforemeals and only take small sips of waterwhile eating. Also, I let my silverware rest. Iset my silverware down after taking a bite.People tend to take a bite of food, and thentake the silverware and scoop it back upagain before they have even swallowed.That can lead to overeating.Lindsey discussed her typical exerciseroutine:I exercise every day. I ride bikes with myson and walk outside or on the treadmill,May 2012 DOs Against DIABETES AOA Health Watch 23
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