I came across an article recently that was supposed to be the 50 reasons to have weight loss surgery.  Actually it turned out not to be a list, but just a way to get me to go to another website.  But the title got me thinking about myself and what my reasons were for having weight loss surgery.  So I started making a list, a very personal list. Some of my reasons were:

1. To improve my back. Carrying 125 extra pounds was wrecking havoc on my back. I was in constant pain.

2. To be able to live a longer and more full life with my husband. We are very active and love packing experiences into life.  I was not ready to just drift through life in pain waiting to die.

3. To improve my health.  Just before my surgery my PCP told me I was pre-diabetic. I have seen what this horrible disease has done to others.  I did not want to go down that path.

4. To set a good example for my daughter. It pained me the way kids had said to her, “Why is your mother so fat?” I wanted her to have a mother who is in control of her life and a mother who has a better chance of being with her for many years to come.

5. To look better. Yes, there was certainly vanity in my reasoning.  I wanted to look good in clothes. I wanted to be more attractive and have pride when I looked in the mirror.  I didn’t want to be ashamed anymore and too embarrassed to go to reunions, weddings, funerals and annual meetings.  I wanted to be able to go places where people would look at me and say, “Wow, she looks good,” rather than “She’s still gaining weight.”

It is always important to reflect on where you have been and how far you have come. So, what are your reasons? Email them to me so I can share some of them and perhaps even put a few in my upcoming book.

Send your reasons to Barbara@WLScenter.com

Dear Barbara,
I am writing this because to this day I have found very little information regarding the absorption of medication and health issues in regards to unknown absorption.  I had weight loss surgery in 2003 and have had several complications along the way.  I researched the surgery for about two years prior to choosing to undergo it.  I had high blood pressure, high cholesterol, severe back problems, etc and wanted to be able to eliminate those health issues.  Unfortunately, the weight loss surgery wasn't enough to beat my poor "genes" that were my fate to inherit, in spite of being successful in my weight loss. I went from a high of 238 lbs. to a low of 116 lbs. and have settled at about 125-130 lbs.  I recently underwent another surgery for complications of a marginal ulcer and bowel adhesions and am recuperating at this moment.

I have constantly researched whether anyone has done or is doing research regarding medication absorption, especially prescription meds.  This issue was the one that I never realized would have such a profound affect on how successful I would feel with this surgery.  Prior to the surgery, I had been a long term NSAID user for arthritis. But, in spite of not ever touching one since surgery, I have developed problems with ulcers including bleeding ulcers.  My doctors and I are in a continual game of trying to determine how much of each of my meds is absorbed, if any, the benefits I am receiving and how to adjust them.  In addition, we are constantly studying which drugs can't be taken within so many hours of other drugs and the effects each has based on how much I am getting.  It is well known that long acting or sustained release meds don't work for us because they are not completely absorbed before leaving the system but what else isn't absorbed well and what kinds of medications am I also possibly getting too little of. 

I was truly hoping that there would have been some studies done on this issue with the weight loss surgery medical community and especially with pharmacists and pharmaceutical companies.  Who better to study the absorption of various medications than pharmacists who understand the make-up of medications, how and where they are broken down within the digestive tract, etc?

I can't believe there aren't more of us who are truly suffering to have medications that work, in the amount that we need in order to be as healthy and comfortable as we can.  Are you aware of any studies or information that has been found on this issue?  I stay in touch with many bariatric post-op communities and try to keep updated on the latest information, but information has been sporadic at best and very little when some is obtained.  So far, I haven't found anyone with any updated insight so I thought I would give you a try.

Thank you so much for your newsletter and website that provides information for weight loss surgery patients.  We really need to be very proactive in our own health care and having people like you to share information is invaluable to all of us who have had, or are thinking about having this surgery.  I truly appreciate any information you can share with me regarding this issue.

Sincerely,
Melody Bracken

Dear Melody,
You are correct.  There is very little written about the absorption of medication following gastric bypass surgery. There are many articles titles that sound promising; however they deal with the absorption of nutrients rather than medications.  In general what the articles state is what we already know and what I have stated in my book, Weight Loss Surgery; Finding the Thin Person Hiding Inside You. http://www.wlscenter.com/Announce_Book.htm

Those statements include:

• NSAIDS such as aspirin products are to be avoided because they cause bleeding which can lead to ulcers.  Since the surface of the pouch is so small, NSAIDS tend to fall on the same area of the pouch all the time resulting in more chance of bleeding.
• Avoid sustained or timed release medications. Because intestines are shorter, the medication is not in the intestines as long and some is lost.
• If at all possible, take medication as shots (intramuscular), injected under the skin (subcutaneous), rubbed on the skin (transdermal), or inhaled through the nose.

I did find one article that was very useful.

Seaman, Jeff S. et al. Dissolution of Common Psychiatric Medications in a Roux-en-Y Gastric Bypass Model. Psychosomatics. 46: 250-253, Je 2005.
http://psy.psychiatryonline.org/cgi/content/full/46/3/250

In the article the authors compare the absorption of many psychiatric medications in pre-op patients and post-op patients. While each medication shows less absorption in post-ops than pre-ops, what is especially interesting is that each medication shows a different level of absorption. So some medications are absorbed better than others. Therefore there can be no general rule as to how much of any one medication is absorbed.  

Further, we are all different. Our surgeries are the same type, but our anatomies are all slightly different. Your pouch and the exact amount of intestines bypassed vary greatly depending upon your surgeon, your own anatomy, and even when your surgery was performed because surgeons have been making pouches smaller and smaller over the years. Because the variances are so great, doctors or pharmacists cannot say that for every bypass patient taking every medication, there will be a certain amount less medication absorbed. The percentages can be all over the place.

It seems that what you are doing with your doctor is the best practice. The medication is to control a condition. Dosage should be adjusted for the best result with the least amount of dosage. It is all very individual.

I want to offer a special thanks to Linda Ambrosini for sharing her success with us. Here is her story:

My story is typical of so many others.  After yo-yo dieting for so many years my regular doctor suggested that I consider weight loss surgery. Bless his heart because he started me on my journey. At this point, I was at my highest weight ever, 299 lbs! 

In August 2005 and at 53 years of age, I attended a seminar given by my surgeon at New York University Medical Center regarding all types of weight loss surgery.  After making an appointment to see him, my surgeon and I decided together that I would have the Lap Band procedure instead of gastric bypass. 

I really feel that people need to understand all of the necessary tests and doctor appointments that need to be done before you actually undergo your weight loss surgery.  It’s not something that happens overnight and can be a nerve-wracking experience waiting for approval from your insurance company, but it is all worth it! 

After dotting my I’s and crossing my T’s, I was turned down initially by my insurance company.  Thankfully, my surgeon’s office had prepared me for this but the disappointment was still there.  After fighting with them and finally being approved, I had my surgery performed at the end of January, 2006.  My wonderful surgeon, Dr George Fielding, has undergone weight loss surgery himself so there’s no one better to answer questions.  He’s been there, done that!

My new life started the day after having my surgery.  While doing my weight loss surgery, my surgeon also repaired a hiatal hernia that was causing me some terrible acid reflux.  The day after my surgery, no more acid reflux! It was the first of many physical ailments that I could cross off my list.  The others that eventually followed were no more sleep apnea and having to sleep with a breathing machine over my face, my knees and joints felt so much better, my heels spurs no longer hurt, and my asthma is gone!

I never allowed my weight to define who I was, but I had a totally new lease on life.  My mental attitude was and is so much better.  Losing weight goes beyond just the physical. I still go past a store window and don’t recognize the confident, thinner woman staring back at me! It amazes me when I go into a store and can wear a “normal” size 12 instead of my former size 24. 

There are still some foods that I’ve learned I can’t tolerate, so I avoid them.  I don’t feel like I’m on any kind of “diet” because I do have a snack every day.  Of course, it’s no longer the snacks that I used to eat nor the amounts but it helps me to eat to live and not live to eat.

I currently weigh 167 lbs so my weight loss is still ongoing but I am no longer obese.  I’ve lost a total of 132 lbs. 

It amazes me what a wonderful tool weight loss surgery can be. It has also helped me to become a much more compassionate person towards others still continuing to struggle with obesity.  Pay it forward, like Barbara does, and help someone else. 

Linda Ambrosini
Ceduxion48@aol.com

Congratulations Linda

“Reprinted from Barbara Thompson’s free e-newsletter featuring helpful information and research material to help patients succeed following weight loss surgery.
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