Current Thinking Oppresses Patients with Diabetes

I am angry with how we think of diabetes.  In fact, I am so angry could scream! Type 2 Diabetes is a monster devouring legs, portions of brains, kidneys, eyes and even people’s very lives every day.

This week I lost another family member that had suffered with Type 2 Diabetes for many years. Two of my immediate family members continue to suffer with diabetes. It is all so unnecessary and it is because our country and our world has the wrong idea about diabetes. We are thinking wrongly and we will not be able to change our world until we change our thinking.

We believe the projections that 30% of our adult population will have type 2 diabetes by year 2030. We accept this as inevitable because the obesity rates are so high!

This is ridiculous. This is unacceptable. We only accept this because we are thinking  wrongly.

We do not have to accept this present paradigm. We know that 90% of Type 2 diabetes is related to obesity. Nearly everyone who reaches a BMI of 40, (for instance, five foot five with a weight of 240 lbs.), will develop type 2 diabetes in time. Some have already developed type 2 diabetes even at a lower weight of a BMI of 35.

For patients with weight high enough to meet criteria for bariatric surgery, sustained weight loss without surgery is very unlikely and therefore dieting and behavior modification is not a solution to this dilemma.  In fact, less than 5% of these people will be able to lose significant amount of weight and keep it off long term without surgery. Diabetic medications decrease blood sugar but the glocose is often forced into fat cells increasing weight over time and making diabetes more dificult to manage. It is a viscious cycle of failure and frustration.

However we know that type 2 diabetes can be prevented by the long term weight reduction that occurs after bariatric surgery. Further, we know that most patients that have had type 2 diabetes for 10 years or less will have no evidence of diabetes after having bariatric surgery and be off most if not all of their diabetic medications.

We need to stop thinking inevitable and start thinking what is possible.

I am no Martin Luther King, Jr. but I also have a dream.

I have a dream that as a society we decide that obesity that reaches a BMI of 40 is unacceptable and a person that finds himself or herself in this situation should have bariatric surgery to prevent type 2 diabetes if they have not developed this disease already.

I have a dream that as a society we will decide that people with type 2 diabetes with a BMI of 35 need bariatric surgery to treat and hopefully resolve their type 2 diabetes.

I have a dream that thousands of amputations, strokes, patients with kidney failure, blindness and premature death will be avoided as we get angry and say we will not accept the death, destruction and suffering any more when we have the medical know how to prevent and treat this monster we call type 2 diabetes.

I am really angry. Our present way of thinking is wrong and dangerous.  Some medical professionals are slowly waking up to the need for some of their patients to have bariatric surgery to prevent or treat this awful disease but we cannot wait. The pace is too slow. Too many are at risk.

Just like breast cancer. If you have breast cancer it is unacceptable not to have surgery and other treatment for that disease. You can choose not to be treated but as a society we believe it is inappropriate. I am not talking about forcing anyone but we need to bring this problem out into the open and take a stand. Obesity is a killer and it is inappropriate not to seriously consider bariatric surgery if a person reaches a certain level of obesity. Why? Because we know the devastation resulting from diseases such as type 2 diabetes and other obesity related medical problems.

We must demand a change in thinking now! Too many lives depend on it.

Will you join me in this righteous anger? Our society needs to change, our insurance companies must change, our government agencies need to change and our medical professionals must change. But this will not happen if you and I do not demand it.

No more amputations.

No more diabetes related strokes.

No more diabetes related heart attacks.

No more dialysis from diabetic kidney failure.

No more blindness from diabetic retinopathy.

No more premature deaths from diabetes.

Are you fed up with diabetes like I am?  Maybe you are so angry you could scream too. Do you have family members suffering from this dreaded disease?  Are you one that suffers from diabetes or at risk for this disease? Type 2 Diabetes indeed is a monster devouring legs, portions of brains, kidneys, eyes and even people’s very lives every day.

We must change our thinking and the thinking of others. Pick up your sword with me and together let us strike blow after blow to fell this terrible dragon and warn others of this danger. Let us dream together of a day when diabetes is viewed by everyone as a preventable and treatable disease. It does not take millions. Only a few good men and women of passion and commitment willing to be filled with righteous anger to slay this deadly monster once and for all.

Are you willing to join me in exploring ways to change the way our culture thinks of diabetes? If so please comment or email me to tell me why you are angry with how we think of diabetes and how this disease has affected you or your family members.

Reflux after a Gastric Sleeve Operation

Most patients do not have problems with reflux after a gastric sleeve operation but reflux can be bothersome for some.  Symptoms of gastroesophageal reflux include heartburn or reflux of gastric contents into the throat or mouth especially when lying down.

When a patient that has a gastric sleeve swallows food , the food travels down the esophagus past the high pressure zone called the Lower Esophageal Sphincter ( LES) at the lower end of esophagus and enters into new stomach call the gastric sleeve. The outlet of this new stomach is constricted by the circular muscle called the pylorus and food and/or drink stays in the stomach for a time and is released only very slowly. The slow release of gastric contents means food remaining in the sleeve may be under higher pressure is able to reflux up into the esophagus and even up into the mouth as the pressure in the gastric sleeve becomes higher than the pressure of the LES.

Patients that are high risk for gastroesophageal reflux after a gastric sleeve operation are those that have symptoms even before surgery. In fact, patients with severe gastroesophageal reflux with pre-cancerous changes in the esophagus called Barrett's esophagus should probably select a gastric bypass instead of a gastric sleeve operation since a gastric bypass is a much more effective way to treat severe reflux.

In my practice, if a patient needs to take medication called a Proton Pump Inhibitor, (Protonix, Previcid, Nexium) every day to control reflux I consider them to have moderate to severe reflux. These symptoms are frequently associated with a hiatal hernia since the opening in the diaphragm where the esophagus enters into the abdomen is often larger than normal allowing the upper part of the stomach to slide up into the chest. In this case if the patient prefers to have a gastric sleeve instead of a gastric bypass I will plan to add an additional component to their gastric sleeve operation by approximating the diaphragmatic muscles behind the esophagus with sutures narrowing the diaphragmatic opening for the esophagus called the hiatus making reflux much less likely. Of course since I use the da Vinci surgical robot this additional step becomes much easier. 

For those patients having reflux symptoms after a gastric sleeve operation I would suggest the following:

1). For mild occasional symptoms - use Pepcid complete or equivalent when symptoms occur. The antacid will neutralize the acid and the Pepcid will decrease the amount of acid the gastric sleeve is making.

2). For more persistant reflux take a Proton Pump Inhibitor as mentioned above each day.

3). Other suggestions include avoiding eating late into the evening, avoid spicy foods and sleep on more than one pillow if possible.

The good news is that the symptoms often improve after the patient loses significant weight and the medications may be able to be discontinued a few months after surgery.