Born in Missouri

Your daughter's academic interests are intriguing. I loved every tidbit that you shared about her. Medical entomology has to be one of the coolest pursuits ever. Parasitology is a favorite of mine as well. I'm also captivated by anything to do with pain management research that involves discoveries like toxic sea snail venom and secretions from waxy tree frogs.

Oops. I don't know why I assumed your kiddo was a son. My daughter is the PharmD. My two middle sons are medical doctors. K lives in Omaha, NE and the older one (the one I mentioned above) is in Pontiac. Actually, C doesn't live in Pontiac, but in a nearby city. I can't remember that city's name now, even though I've been there! My youngest son wanted nothing to do with medicine. He's studying computer engineering. Go figure.

Bariatric surgery was named in 1953, after the Greek word “βάρΟς” for weight, when Varco first attempted to treat severe obesity with a bypass of the small intestine. Since then, the field has expanded to control diseases that include type 2 diabetes mellitus. In 1995, Dr. Walter Pories and his research team published an article titled “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus”. Since then, evidence has accumulated showing that weight-loss surgery can cure/improve several metabolic diseases, especially adult onset or Type 2 diabetes mellitus. Obesity is tough to combat using behavioral interventions, with studies showing only moderate weight loss and frequent weight regain. Many diabetes patients struggle to control blood sugar and other metabolic disorders, despite a wide range of available pharmacologic options. Metabolic surgery is designed to benefit patients with type 2 diabetes, in whom obesity is often a major underlying factor. The term "metabolic surgery" indicates a surgical approach whose primary intent is the control of metabolic alterations/hyperglycemia in contrast to "bariatric surgery," conceived as a mere weight-reduction therapy. Metabolic patients tend to be older, male, have a lower BMI, and have diabetes. Bariatric patients tend to be younger, female, have BMIs double the ideal weight for height, and have an average of three to four obesity-associated co-morbid conditions such as pre-diabetes, hypertension, sleep apnea, arthritis, and polycystic ovarian syndrome. Metabolic surgery is defined as a set of gastrointestinal operations (such as sleeve gastrectomy or Roux-n-Y gastric bypass) performed with the intent to treat diabetes and other metabolic dysfunctions, which include obesity. In 2009 the American Society for Bariatric Surgery (ASBS) changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS) to promote information on the beneficial effects of surgeries for weight loss in treating metabolic diseases, especially Type 2 Diabetes Mellitus (T2DM) . https://www.ncbi.nlm.nih.gov/pubmed/23314274 https://diabetes.medicinematters.com/metabolic-surgery/type-2-diabetes/metabolic-surgery-a-powerful-solution-or-a-last-resort-/12343792 https://weightlosssurgery.ca/surgery-type-2-diabetes/what-is-metabolic-surgery/ So, if you're having weight-loss surgery primarily to treat diabetes or pre-diabetes, or even if you aren't having surgery for that specific reason, you still might want to inform your co-workers or any judgmental extended family members that, "I'm having metabolic surgery next week, so I'll be taking a few days off to recoup." metabolicpal.com?

I mix FAGE Total 2% plain yogurt with 20g of Protein with Bio Chem unflavored whey protein 20g. I don't taste the protein powder. There's no gritty texture. In fact, it's richer and creamier now. If I hadn't been the sneaky culprit who spiked my own yogurt, I'd never notice the protein powder in there. After my post-op protein struggles, I'm finally getting some protein. Still not the recommended amount, but a whole lot more than before.

I have a colonoscopy every 5 years. I agree. Don't miss 'em.

Opioids as part of a pain management plan should be used in cases of moderate to severe pain, and for as long as needed if that condition turns chronic. I have long stopped feeling ashamed for needing opioids to manage my pain. I would be unable to walk or get through my day if my pain wasn't knocked down to some degree. There is no shame in opioid dependence for legitimate pain. I'm addicted to pain relief and the opportunity to have a quality of everyday life without pain. I think the study was about people who started with an opioid prescription but continued taking opioids long after their post-op pain ended. Taking opioids beyond that point is the concern. Believe me, people who take opioids for chronic pain, don't experience a "high", we're just grateful that our medication has taken the edge off the pain. My pain is never absent, and often even my morphine or oxycodone can't touch it, but it makes the pain almost tolerable. For almost two years, my primary and I tried every conceivable alternative to opioids. I suffered a lot during those early times. It took my pharmacist daughter to finally convince me that I needed something stronger, something that could best compete with my pain. Your friend's pain management plan most certainly required the use of opioids and would in no way be considered "abuse". I don't think this study intends to deprive anyone of their valid use... only their continued use if the reason for the medication ceases. How is your friend doing now? Did physical therapy help with her healing? It's a tough road for a while, I know. I had both knees replaced (three months apart), but, fortunately, for me, all went well. I wish for your friend a happy TKR ending, too.

@Creekimp13 Thank you for breaking it down. I pretty much just hit the highlights of the study, so it's great that you're able to pull out the numbers and get to the core of the study. This is definitely good news for those who've opted for the sleeve.

@Creekimp13 Excellent information and follow-up. I loved your personal testimony paragraph. My oldest son completed his medical fellowship at UM-Ann Arbor and now lives and works in Pontiac. I hope through you and your talented son you can keep us up-to-date on this research topic. I personally find it fascinating. No thoughts of witchcraft here. Pure science and purely amazing. Thank you.

I don't know anything about the extra week you might be facing, but that extra week would be worth it since, according to this article, bariatric surgery is an effective treatment for the most common cause of a fatty liver. Nonalcoholic fatty liver disease is becoming one of the most common causes of liver disease in the western world. The most significant risk factors are obesity and the metabolic syndrome for which bariatric surgery has been shown to be an effective treatment. The Effect of Bariatric Surgery on the Spectrum of Fatty Liver Disease https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5061986/ Several drugs also cause fatty liver, including: corticosteroids, tamoxifen (Nolvadex), and methotrexate (Rheumatrex, Trexall). Fatty liver is usually found or suspected when: Abnormal liver tests are found on routine blood testing Fat is seen ultrasonographically when ultrasonography of the abdomen is performed for other reasons, for example, the diagnosis of gallstones Infrequently when the liver is enlarged on physical examination of a patient

@Frustr8 I'm going to hold you to that promise. This study knocks the wind out of the widely-held claim that gastric bypass is superior to the sleeve in terms of greater weight loss. Darn! And here I was feeling all "abdominally" superior and crap...

Three-quarters of severely obese patients had unhealthy, not very diverse gut microbes (low microbial gene diversity). This unbalance was associated with a greater tendency to have a high-fat mass in the trunk of the body and an increased likelihood of having type 2 diabetes, hypertension, or more severe versions of these comorbidities. According to the researchers, more work is needed to determine "whether specific interventions (specialized diets, prebiotics/probiotics, or gut microbiota [fecal] transfers) may be useful to consider prior, or post, bariatric surgery in severely obese individuals." "This is "an exciting field" of research… one day we'll probably have the perfect combination of gut organisms in a fecal pill form.”--Samer G. Mattar, MD, president of the American Society for Metabolic and Bariatric Surgery (ASMBS). https://www.medscape.com/viewarticle/899158

A study suggests that people who undergo a momentous life event such as weight loss surgery may possess a “bias to action,” -- meaning they may be encouraged to make additional life changes, like getting a new job, getting married or divorced, or moving. https://www.everydayhealth.com/diet-nutrition/bmi/getting-bariatric-surgery-unexpected-way-your-relationship-status-may-change/

Patients who underwent surgery had a 77% decreased risk of developing hormone-related cancer (breast, endometrial or prostate cancer) when compared with patients who did not have surgery. Gastric bypass resulted in the largest risk reduction (84%) for hormone-related cancer but was associated with a greater than twofold increased risk of colorectal cancer. https://www.sciencedaily.com/releases/2018/07/180716103541.htm

Question: Is there a difference in weight loss between laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass in patients with morbid obesity? Conclusion: This study did not find a significant difference in weight loss between sleeve gastrectomy and gastric bypass at 5 years of follow-up after surgery. https://jamanetwork.com/journals/jama/fullarticle/2669728?resultClick=1

Nearly 9 percent of bariatric surgical patients who did not take opioid pain medications until their weight-loss operation, or the month before it, report that they are still using prescription opioids one year postoperatively, according to the results of a Michigan study, presented at the American College of Surgeons Clinical Congress 2017. http://www.bariatricnews.net/?q=news/112870/bariatric-surgery-patients-vulnerable-opioid-dependence I was an opioid (morphine) pain patient before my gastric bypass surgery, btw.

@Tealael. What couldn't you find out... whether she's a pharmacologist or a PharmD? Now that I think about it, if she works in a hospital, she has to be a clinical PharmD. Pharmacists require a license to practice pharmacy. While PharmD's also study pharmacology, that is not the focus of their expertise. My daughter studied for 5 years plus one year of residency at a Veteran's Hospital. I'm very proud of her. Again, you're lucky that your program makes a concerted effort to help their patients with as many meds as they are able, despite the lack of data available for bariatric patients. I remember when I first brought up the topic of medication malabsorption at my first surgeon appointment. I could tell from Dr. S---'s expression that he didn't like how specific my questions were, and then, he surprisingly changed the subject. I knew then that I'd have to figure out my meds pretty much by myself... with the help of my kids and other health professionals whose egos allowed them to admit that there's not much research out there to go on. As for your questions about the requirements for COE certification, I found this link (below). I'm not sure, but I think a hospital can be a COE hospital independent of being COE certified for every program they're involved in. I don't think the hospital I had my bypass in was COE certified for bariatric surgery, even though it was a COE-certified hospital in other areas. I had two full knee replacements at this same hospital, and I don't know if they were COE certified for knee and hip replacements either. Too late now. Maybe if I have to have a brain transplant someday, I'll make sure it's at a COE-certified hospital for brain transplants! https://www.obesitycoverage.com/insurance-and-costs/pre-approval-process/center-of-excellence Some of the programs that a hospital can receive COE certification for include: bariatric surgery knee and hip replacement maternity care spine surgery transplants Oh, and I'm happy to have a new case-study buddy (aka someone who enjoys researching medical and scientific articles too!)

I added magnesium citrate to my supplements. I had no idea that there were so many forms of magnesium. https://www.globalhealingcenter.com/natural-health/types-of-magnesium/ Despite, what is said in this article, when it comes to the bariatric community, the form that works best for us is magnesium citrate. Take magnesium with calcium for better absorption. My cramp hasn't improved yet, btw. I hope the magnesium helps soon if that's the cause for my pain.

@Tealael Visualization sounds like a worthwhile way to help me see myself as I hope to be. I think I'll send myself through a bariatric portal to Iceland. I love snow and all that is winter. Thanks for the inspiration!

@Tealael Most likely she's a PharmD, which is a Doctor of Pharmacy. My daughter is a PharmD. A pharmacologist is basically a researcher. They study the chemistry of drugs and how they work in our bodies. Drug companies hire pharmacologists. A PharmD can be a clinical pharmacist (works in hospitals or nursing homes) or a retail pharmacist (fills prescriptions at drugs stores like CVS or a mail-order facility). No, I have no qualms about her thoroughness. That's what PharmDs do. But that doesn't change the fact that little is understood about the interactions and malabsorption unknowns with the majority of drugs as they pertain specifically to the bariatric community. You're lucky that someone is hands-on with your meds, but she is basically working off what little is known and applying that knowledge as best as she can to the patients she serves.

I just realized that this is an old, archived post and the original poster hasn't even visited this forum for at least a couple of years. I hope other people will read about and learn from this thread anyway.

@Tealael Also, congrats on all the weight you've lost. I'm still having a hard time imagining myself a year or so from now and enjoying your level of success. Wow.

@Tealael Doctors, including bariatric surgeons, know very little about the effects of most meds out there when it comes to helping those of us in the bariatric community feel confident about the meds we take, prescription and OTC. I'd be interested in seeing the list they've compiled and their reasons.

I was interested in this topic recently, too. https://www.bariatricpal.com/topic/416632-altered-taste-buds/?tab=comments#comment-4657450

@sillykitty. I talked to my youngest doctor son and he pretty much, but nicely, let me know that I didn't actually have a good grasp on the TOTAL PROTEIN test. His explanation was way over my head. All I remember him saying was something about children in poor countries who are protein-starved... I think, I'm still not sure. That said, I stand corrected. I'm the first to admit when I've mispresented a medical fact. Another confession!!!

I found two interesting slideshows on the site Matt recommended to calculate one's BMR. https://www.active.com/fitness/articles/10-surprising-reasons-you-re-not-losing-weight https://www.active.com/food-and-nutrition/articles/8-ways-to-eat-more-protein Obviously, some of us haven't graduated to some of the foods suggested... yet. I'm not terribly disappointed in not being able to eat turkey jerky anyway.