Thursday, April 2, 2009

Neuropathy, gastric bypass linked

This should give people another reason not to have WLS.
Sami Harik did not think it was an accident that he was seeing neurological problems in patients who had had gastric bypass surgery.
Harik, chair of the department of neurology at the University of Arkansas for Medical Sciences, got some flak when he told a patient who'd had the weight-reduction procedure that her neurological symptoms were being caused by a vitamin deficiency brought on by the surgery. The patient reported what Harik said to her surgeon, and the surgeon sent Harik a “frosty letter,” challenging Harik to produce data.

This does not surprise me at all. From everything I've learned on the OSSG-gone_wrong group, most WLS surgeons refuse to acknowledge that any complications patients get are from the surgery (and if they do acknowledge complications, they say those complications aren't nearly as bad as what can happen to a patient if said patient stays fat). They want proof, but a lot of them don't do any follow-up for more than 6 months or a year with any of their patients (and if you have problems, they'll refuse to treat you).
Now, Harik and colleagues in the neurology department, including lead investigator Dr. Katalin Juhasz-Pocsine, have published a study based on patients who've been treated by the department for the last 10 years. The results, reported in the May 22 issue of the medical journal “Neurology”: Of the 150 patients who'd had the Roux-en-Y bypass surgery before being treated at UAMS' Neurology Clinic, the symptoms in 26 patients could be directly linked to the surgery.

26 out of 150 patients - that's 17% with neurological complications from WLS. That is not a number that is part of the "informed consent", and that's not a risk I would be willing to take (my VBG just shrank the size of my stomach, it didn't bypass any of my intestines).
It started, for Poscine, with a patient in her 30s who came in complaining of tingling in her feet. Poscine ruled out diabetes, which can cause neuropathy in the limbs. Poscine determined she was deficient in vitamin B12 and iron, and began giving her patient IV nutritional supplements and making sure that she was eating. But the patient declined; three months after her first visit, she could no longer walk and, bedridden, required complete care. Her body could not absorb what it needed to repair the problems.
Poscine persuaded the patient to agree to a partial reversal of her bariatric surgery. A section of bowl that had been bypassed was rejoined to the stomach so that more nutrients could be absorbed.
In three more months, she could get out of bed. A year out, she can walk again and is much improved.

This patient was lucky, not all reversals are that successful and show results that dramatic. Bariatric surgeons know that these surgeries can cause nutritional deficits, and supposedly tell their patients what vitamins and how much of them to take, and that they will have to take them for the rest of their lives. What they don't tell them is that all the vitamins recommended sometimes aren't enough and that the lab values that are considered normal for anyone who hasn't had WLS are not normal for someone who has had WLS and those "normal" values can, in fact, be dangerously low for them (and those patients don't find this out until they start having problems). Why do bariatric surgeons not know their patients are having these problems? Because these problems don't always show up right away. Sometimes they don't show up for years (5, 10, 15, or 20 years down the road) and these surgeons don't follow WLS patients for nearly that long.
“We are not saying patients should not get the surgery,” Poscine said, but that they need individualized supplementation and careful, lifetime follow-up. Harik estimated the percentage of bariatric patients who get into trouble as less than five percent of the population.

WLS patients need individualized supplementation and careful, lifetime follow-up all right and I can guarantee you that their surgeons aren't going to do that follow-up and they aren't going to refer patients to doctors who can, and will, do that kind of intense follow-up because if they have to tell patients this before they have the WLS, they just might have second thoughts about having this surgery.
What the WLS surgeons don't tell their patients is that most vitamins and supplements that they need to take don't always work if taken orally (surgically induced malabsorption doesn't just keep calories from being absorbed, ya know?), and that a lot of what they need to take will have to be done as injections or given by IV.
Still, bariatric surgery is growing exponentially, Poscine said, and doctors need to be vigilant to make sure their patients with intentionally compromised digestion get immediate treatment of neurological problems. She is particularly concerned that bariatric surgeons take to heart the results of the study, since, she said, few follow their patients over a long period — and many don't believe the study's premise anyway.

And this is the major problem with WLS - too many surgeons don't believe that the problems their patients are having are a result of their mutilated digestive tracts because they don't have to follow their patients long-term. After all, how much money can you make if you can't spend all your time in surgery? If you have to spend half of your time with follow-up care (which pays a lot less than surgery) you aren't going to make as much money as if you spent most of your time in surgery and a little bit of time convincing patients that you have the "magic cure" for all their ills in this one little life-altering surgery (too bad they don't tell you that the "life-altering" isn't always good, and can be fatal or debilitating).
These problems with WLS have been happening for more than 30 years and WLS surgeons don't give a shit. How many more fat people have to die, how many more fat people have to suffer debilitating complications and worsened quality of life before they figure out that being fat is not a fate worse than death?
I wish, by everything I hold dear, that I could have now the quality of life I had before I had my WLS, and I don't have nearly as many complications from my WLS as a lot of people do, and I'm still alive, unlike a lot of fat people who have gone through this shit. And I can guarantee you that my quality of life is worse now than it was 12 years ago. 12 years ago, I could do my shopping at Cub's or Wal-Mart without having to use an electric cart, I could walk through a mall for half the day shopping and not be in severe pain halfway through it, I could eat a meal at a restaurant and not have to be aware of where every bathroom was and make sure that one was within 50 feet of me at all times, just in case. I could climb stairs without having to use the handrail to pull myself up them (and I wasn't out of breath because I was in so much pain from climbing the stairs). Yeah, WLS sure did improve my life a lot.......NOT! And that's why this kind of thing pisses me off and why I blog about it and why I risk embarrassment from telling those TMI bits - because I don't want anyone else to suffer what I've been through, or to suffer even worse than what I've been through (just take a look at the complications list I've posted before, you'll see what I mean).

16 comments:

  1. This looks pretty juicy - would you share the citation for the original research? Thanks!

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  2. below-the-belt - I don't know why my link (This) didn't work, but if you click on the title of the post, it will take you to the article in the Arkansas Times (one of the members of OSSG posted this to the list today, and she had posted it to the list in August of 2007 also, before I became a member of OSSG-gone_wrong).

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  3. ok, now This and the title of the post are links to the article (my bad, i should have proofread my html before posting).

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  4. That's what kills me about all the "butbutbut WLS CURES DIABEEETUS!" hype. Even if it did -- and the evidence is sketchy at best -- if I had a choice between diabetes and, oh, let's see, chronic pain, bone loss to the point of teeth falling out and everything else snapping like a twig, beriberi, rickets, scurvy, kwashiorkor...shit, give me diabetes any day.

    Andee (Meowser)

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  5. Well, it does seem kind of obvious, no? I mean several neurological disorders can be directly linked to nutrient or vitamin deficiency including, in worse case scenarios, Beri-beri. Soooo. . . . Neropathy? Not such a wild idea, huh? Unless, of course, your more concerned about tarnishing the image of the greatest, most successful, treatment for this 'disease' of obesity, since sliced. . . . Well, stomachs, I guess would be technically correct. Which would be a large part of the problem here. Some Dr's are NEVER wrong. The patients diagnosis is just more complicated than it originally appeared to be.

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  6. Well written...
    Honestly, the whole WLS situation just makes me so sad... atm, I have no other words than that... sigh...

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  7. I'm no expert but, I did take a nutrition class to satisfy a science requirement and I had to learn what all the vitamins and minerals do inside the body and what happens when a person has a nutritional deficit. I then took a class in psychopharmacology as a free elective and learned how the brain worked and how if one isn't getting enough of a given vitamin or mineral that the brain needs it will go there as a survival mechanism. Bearing that in mind, I can't say I'm terribly surprised about this news and yet surprised that it isn't worse. What would be interesting would be to see an MRI of someone pre-op and post-op to see if their brain is working the same or differently.

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  8. How ironic that what has been touted as a 'cure' for T2 should have symptoms in common with T2 itself, yet again the cure becomes the disease.

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  9. This is a great takedown, and thank you for bringing this to our attention and sharing your own story. Most people just don't want to know about the risks of WLS, so they stick their fingers in their ears and pretend you just get thin and everything is great. You force us to confront the reality for so many people.

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  10. Sandy - the comment feature on blogger can be wonky at times (if you aren't signed in to your wordpress/blogger/open ID/whatever, it may or may not let your comment through. But I did get your comment that you couldn't comment, so go figure.

    spacedcowgirl - thanks :) I figure if just one person reads this stuff and reconsiders, then everything I'm doing is well worth putting it all out there, trolls and all.

    wriggles - yeah, I'd much rather have the diseases themselves than the complications from WLS. At least the diseases usually have a known cause/cure/treatment, while the complications from WLS are ignored or said to be the patient's fault or caused by something other than the WLS and the treatment for those complications doesn't always help, unfortunately.

    pippin85 - it would be interesting indeed to see MRI scans of a patient's brain pre-op, post-op, and at yearly intervals to see the progression of deterioration (and it does happen, to quite a few WLS patients, according to what I've read at OSSG-gone_wrong).

    AGR - yeah, it makes me sad, but it also makes me angry. That anger is a good thing, I think, as that's what keeps me going and keeps me blogging about and commenting on anything WLS-related.

    bilt4hugin - yeah, it's obvious to us, but not to the medical community who are profiting from pushing WLS as a "cure" for "obesity" and whatever else they think is related to being fat.

    Andee J - my thoughts exactly. I'd much rather have diabetes than try WLS to get rid of it. Diabetes can be treated and controlled a lot easier than most of the complications from WLS (and the same goes for most of the things doctors say are "caused" by being fat). When I applied for SSDI, the Social Security doctor I saw recommended having RNY WLS since my VBG didn't work, and I told him in no uncertain terms that it wasn't happening. They had their one chance to kill me, and I wasn't giving them another, thank you very much.

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  11. This sort of thing reeeaaally worries me. My mother had the lap band put on maybe a year ago. She's been crowing about her "superb" weight loss ("Even faster than average!") ever since. She smiles and is happy about it while I anxiously note all the downsides she tries to avoid talking about. I worry that her WLS (which was supposed to save her from The DeathFat) is going to usher her into an early grave. :(

    The only point of light is that she seems to be having pretty regular follow-ups and the lap band is apparently somewhat less deathly than bariatric.

    Thank you for pointing out this study for us, though. I'll keep it in mind when I talk to my mom, and hope that I never need to know about it.

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  12. Your take on this is right on Mariann. You always get my mind thinking and rethinking my stances, and I love that!
    I don't think I've ever heard your whole WLS nightmare story. Do you have a link to it somewhere? I would be interested in hearing about that journey in more than just a blurb or two. I hope that's not being invasive.
    Also, I have been struggling with trying to determine whether the cause of my aches and pains are due to getting older, my weight, arthritis, or some combination. I am reaching a point in life of just "accepting" me at the stage I am without the need to find a cause or culprit to point the finger at. I have grown weary of the struggle to be perfect and am starting to just enjoy and embrace every new wrinkle, stretch mark, creaky joint, back pain, and gray hair. It doesn't always work, but it's keeping me sane.

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  13. Regina, I'm with you. I also find it helpful to embrace aging. It helped me that women in my family seemed a heck of alot happier as they got grayer and wrinklier... it set me up to look forward to aging and the maturity and peace that comes with it.

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  14. This is a great takedown, and thank you for bringing this to our attention and sharing your own story.

    Gastric Sleeve Surgery Mexicali

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