Wernicke’s and bariatric surgery

I have had weight loss surgery about 5 years ago. Three years ago I was diagnosed with Wernicke’s encephalopathy after almost dying. Further symptoms are: EXTREME fatigue, falling/tripping, loss of grip in hands, eyesight diminishing,a rash noted on extremities. And of course loss of memory. But one of the worst symptoms is burning, feeling like you were dropped into a volcano and left there. The only reason my condition was recognized was that I was working with two bariatric surgeons at the time. For now my physical condition is stable. I take daily B1 (Thaimine) injections, weekly B12 injections, Lexapro for depression, Elavil mixed with Neurontin for nerve pain and handfulls of vitamins. If you are considering this surgery, make sure the dr. maintains an aftercare secion of his practice, the surgery takes 45 minutes to an hour, you have to live with the results 24/7.

Mr. Lucas – While I agree with you in regards to the social effect of removing PCP’s from the work force at a time of crisis, I would point out several issues:
1. The article mentioned notes that the weight loss activities would be in addition to the normal practice activities of the PCP, and
2. …”realize medicine is a business and maximizing profit is it’s only goal”…may seem to cruel and unusual, but it is a very real fact of life. The usual office practice, PCP or specialist, must garner enough income to pay the fixed costs of practice every month – insurance, rent(s), staff, local taxes, then cover the variable costs of consumable items used in the course of business and medical care in the facility. That will require from $7 – 17,ooo per month (“Your mileage may vary”) and includes the cost of providing after-ER care for indigent patients seen on hospital call, admitted or not.
3. IF the government – Medicare and Medicaid, and EMTALA- used other than economic tools to effectively ration care, then the office would have less need to respond as a rationale economic actor to externalities imposed by the feds and state.
In addition, the vigorous tightening of reimbursement levels in the private sector, in combination with the wearisome paperwork requirements for same, add fuel to the fire.
In summary – if we cannot respond as a labor force due to antitrust concerns, while all around us the compression of payors leads to private and governmental monopsony, many will leave, few will follow, and those left will have no choice but to seek arbitrage opportunities – Boutique offices, weight loss centers, employed status. etc.

Realize this, however – NONE of us in my class in medical school 1977-1981 ever knew we would be in this mess, never planned to be neck deep in this level of business activities and bureaucracy – and the next generation of physicians in these setting will be much better and more aggressive entrepeneurs than we ever dreamed of, and we’ll have to see how that works.

Thoughts about Obesity

Obesity has been defined as when excess body fat accumulates in one to where their physical overgrowth makes the person unhealthy to varying degrees. Obesity is different than being overweight, as others determine obesity to be of a more serious concern.
As measured by one’s body mass index (BMI), one’s BMI of 25 to 30 kg/m is considered overweight. If their BMI is 30 to 35 kg/m, they are class I obese, 35 to 40 BMI would be class II obese, and any BMI above 40 is class III obesity.
Presently, with obesity affecting children progressively more, the issue of obesity has become a serious public health concern.
Approximately half of all children under the age of 12 are either obese are overweight. About twenty percent of children ages 2 to 5 years old are either obese are overweight. The consequences of these stats on our children are very concerning, considering the health issues they may or likely experience as they get older.
Worldwide, nearly one and a half billion people are either obese or overweight. In the United States, about one third of adults are either obese or overweight.
Women of low socioeconomic status are likely to be twice as obese compared with those who are not at this status. It is now predicted that, for the first time in about 150 years, our life expectancy is suppose to decline because primarily of this obesity problem.
Morbid obesity is defined as one who has a body mass index of 30 kg/m or greater, and this surgery, along with the three other types of surgery for morbid obesity, should be considered a last resort after all other methods to reduce the patient’s weight have chronically failed. Morbid obesity greatly affects the health of the patient in a very negative way. It has about 10 co-morbidities that can develop if the situation is not corrected. Some if not most of these co-morbidities are life-threatening.
One solution beneficial in many cases of morbid obesity if one’s obesity is not eventually controlled or corrected is what is known as gastric bypass surgery. This is a type of bariatric surgery that essentially reduces the volume of the human stomach in order to correct and treat morbid obesity by surgical re-construction of the stomach and small intestine.
Patients for such surgeries are those with a BMI of greater than 40, or a BMI greater than 35 if the patient has co-morbidities aside from obesity. This surgery should be considered for the severely obese when other treatment options have failed. The standard of care illustrating as to whether this surgery is reasonable and necessary should be clarified.
There are three surgical variations of gastric bypass surgery, and one is chosen by the surgeon based on their experience and success from the variation they will utilize. Generally, these surgeries are procedures related to gastric restrictive operations or mal-absorptive operations.
Over 200,000 gastric bypass surgeries are performed each year, and this surgery being performed continues to progress as a suitable option for the morbidly obese. There is evidence that this surgery is particularly beneficial for those obese patients that have non-insulin dependent Diabetes Mellitus as well.
It is believed that the results of this surgery to correct morbid obesity greatly limits or prevents such co-morbidities associated with those who are obese. Yet about two percent of those who undergo this surgery die as a result from about a half a dozen complications that could occur. However, the surgery reduces the overall mortality of the patient by 40 percent or so, yet this percentage is debatable due to conflicting clinical studies at times.
Age of the patient should be taken into consideration, as to whether or not the risks of this surgery outweigh any potential benefits for the patient who may have existing co-morbidities that have already caused physiological damage to the patient. Also what should be determined by the surgeon is the amount of safety, effectiveness, and rationale for a particular patient regarding those patients who are elderly, for example.
Many feel bariatric surgery such as this should be considered as a last resort when exercise and diet have failed for a great length of time.
If a person or a doctor is considering this type of surgery, there is a website dedicated to bariatric surgery, which is: http://www.asmbs.org,

Dan Abshear