Posted by:
PtLoma
(
)
Date: July 07, 2011 12:01PM
I am an internist and several of my patients have had gastric bypass. One has had lap band/sleeve surgery. All of them are male, one is LDS but not TBM (but does not drink/smoke, and food I think became an addiction).
#1. 6'3" man about 40 years old. 750 lbs and mobile (held three jobs). Other than back pain, had no obesity-related health issues: cholesterol fine, BP fine, no diabetes, no sleep apnea. Had bypass, dropped into the mid-low 400s, but then began to gain it back (and stopped coming to the office because he didn't want me to note the weight gain). I think he was drinking alcohol (like a quart a day) and this plus immoderate eating resulted in a gain-back of c. 200 lbs. He suffered a fall, leg fracture, and then lost the ability to walk once he was bed confined for a week. This often happens with super-heavyweight patients: they lose the ability to walk after something sidelines them, then they become bed bound and never walk again. He was placed in a rehab center for the immobile (out of town) and I have lost track of him, don't know if he is alive or dead. He became addicted to pain medications once he was bedridden.
I should note that all of the men in this patient's immediate family (even cousins as well as brothers) were 6'3" or taller, and none were under 300 pounds, and none had any weight-related health issues. It was "normal" in his family to be >6'3" and >350 lbs, but not 750 lbs.
#2: former Pac Ten football lineman, 6'4" and peaked at 450 lbs. Had BP issues and back/joint pains. Cholesterol and blood sugar normal. Had horrible sleep apnea. This guy played at c. 300 and was very big boned and muscular (picked up the back of a car in his 40s to help someone change a tire) and 280-300 post-surgery would have been a reasonable goal. He dropped 150 lbs and now is stable at 300, which is fine for him (he's big no matter what). Apnea gone. BP gone. Back pain gone. About the only thing he's still treated for is gout (genetic, but he's much better off being 150 lbs smaller).
#3: (LDS) man in his 60s, 6'4" and close to 400. Diabetes and high blood pressure. Did lap band. Now down to 320. Diabetes and BP still there but much better and easier to control. Is slowly working his way down to <300 (and again, 250-275 would be ideal for this large frame person).
#4: Former high school linebacker, got up to 350 lbs on a 5'11" frame. Dropped to 235 and stable after bypass. BP and apnea gone. Has had severe problems with not absorbing iron and B12, now takes both for life but blood count now normal again because he's absorbing them.
Some of the things to be aware of with a bypass:
1. You can't take NSAIDs (ibuprofen, naproxen etc) if you later develop arthritis
2. You will probably have absorbtion issues with B12 and iron. These can be ameliorated by taking daily sublingual B12 lozenges (or shots) and daily iron supplements.
3. Some people have trouble making the psychological adjustments. For people who were solitary/closet eaters, they have to do something else with their time when no one is looking. The patient who had the hardest adjustment was #2. He was wealthy, huge restaurant bills were no big deal, and he was single, so that a great deal of his social life consisted of sumptuous restaurant meals with friends, where he always picked up the tab. Rather than being a closet eater, he almost reveled in finishing off oversized multicourse restaurant meals in public with friends. Part of it was so he could be generous (taking friend out to restaurants they normally could not afford) and I think a part of it was his pride in being "the biggest man in the room": I think he prided himself on being able to polish off a huge meal while others' jaws dropped, he prided himself on being the one asked to help with heavy lifting tasks (like picking up the back of a car when a jack could not be located), and even when strangers went up to him to ask how tall/heavy he was, he didn't mind being the object of attention. He was always well tailored and looked sharp in brand-name clothes (albeit in big/tall sizes), like an overgrown lumberjack in a business suit. To go from that to being able to eat only half a container of yogurt at once was a big change for him, and the new lifestyle deprived him of a major social life outlet: going out to dinner with friends. He knew it was healthier this way, but I think he missed the "admiration" of people at the table who marveled at his appetite in the past.
Technical notes: at the office I have an electronic scale with an 18" square footplate and a 500 lb capacity. I do not practice bariatrics, but my old scale had a 350 limit and I don't like telling a patient larger than that "sorry, you're off the scale". I would rather tell them "398" than "sorry, you're too big for the scale". The old scale was a double beam balance type scale with a smaller footplate. Some of the larger patients (the ones who are 6'3" or taller) have pretty large feet---15 EEE not uncommon, and people with size 15 and greater feet had trouble placing all of their feet on the footplate---usually their toes or heels would overhang the plate, which is dangerous and gives false readings. With respect to the 750 lb man, the only way I could measure him was to send him to a nearby garbage dump, where they had a truck scale. He would weigh himself in his truck, then get out of the truck and weigh the truck only. The difference was his weight, but in 0.01 of a ton (20 pounds), so the weight estimate was based on 0.37 tons or 740 pounds, roughly, give or take 10 pounds. When he gained the weight back after the bypass, I could estimate about 200 lbs gained because I remember what he looked like at c. 650 before he gained the final 100 pounds up to 750.
Edited 2 time(s). Last edit at 07/07/2011 12:09PM by PtLoma.