Bariatric Patient Compliance Study - copied from OH main board

A new study released online January 27, 2010 demonstrates that compliance with nutrition is a challenge for many bariatric surgery patients.  The study, titled Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient, looked at bariatric patients admitted to a single hospital years after their bariatric procedures (admissions for other causes).  

Researchers evaluated what they were doing for supplementation at the time of admission and compared this to current ASMBS guidelines.

Most of the patients were 3-7 years post-op, 87% were roux-en-Y gastric bypass.  On admission only 33% were taking a multivitamin and only 5% were taking B12 .  Problems were also noted with iron, calcium, folic acid and vitamin D supplementation.  In addition, researchers found numerous medication errors, the primary problem being the use of slow releasing medication forms in patients with malabsorptive procedures.  Overall, this study points to the continued need for both bariatric surgery patients and healthcare professionals to be better educated on appropriate nutrition and medication protocols. 

Reference: 
Lizer MH, Papageorgeon H, Glembot TM. Nutritional and Pharmacologic Challenges in the Bariatric Surgery Patient.
Obes Surg. 2010 Jan 27. [Epub ahead of print]

Link to abstract: Click Here

Reviewed and Prepared by:
Jacqueline Jacques, ND 
Chief of Scientific Affairs 
Bariatric Advantage 

So, people do not take their vitamins.  We knew this. "They are yucky!  They are expensive!  My labs are fine!  I had surgery a long time ago, I'm fine!  I forgot!"

Now, I was not aware that extended release meds were a no-no.  I take one.  I specifically ASKED the doctor about that.  "Don't worry about it."  (Is this why I still have issues?)  So, I need MORE information, please!

Which took me approximately five seconds to find.  @@ How do I not KNOW THIS?!  And, further, why am I prescribed it?

 Reductions in drug absorption are more frequently encountered in patients who have had combination restrictive–malabsorptive procedures. Decreased intestinal length and surface area lead to the reduced absorption of extended-release drug preparations because these formulations are absorbed over 2–12 hours.^[27] The reduction in functional intestine length makes it likely that extended-release preparations have passed through the gastrointestinal tract before absorption is complete. These same principles can also apply to delayed-release and enteric- or film-coated product formulations. ^[28] To overcome this problem, the immediate-release dosage forms should be substituted, which could require increased frequency of administration.

 

I see this ALL the time at work.  I have patients who list RNY as a past medical history.  Then I ask "do you take any medications including vitamins, supplements, prescriptions, over the counter, or herbal supplements?"

No.

I've gotten pretty vocal about it to those specific patients.  "You don't take a multi vitamin?"  No. "Calcium?"  No.  Sometimes (but VERY rarely) a patient will go "Oh - yea - I take x y and z but I didn't realize you wanted that stuff, too" (IE why I said vitamins, over the counter etc thank you very much)

And a lot of the time these are the same people that have one of two complaints.  A)  "The surgery didn't work" or B)  "I've had nothing but trouble since that surgery"  Well....if you don't do your own research....and you don't follow the plan....then that's what you get.

And yes, I kind of agree that Primary doctors and stuff should know not to give extended release meds (by the way those same extended release meds CANNOT be crushed) but the reality is - a primary CANNOT know all the ins and outs of every procedure or medical problem one of their patients might encounter.  The fact of the matter is, I believe EVERY patient should know AS MUCH AS POSSIBLE about THEIR condition and what they can and cannot do. 

Do I expect them to know which drugs are extended release?  No.  But I do expect them to ASK any prescribing doctor those types of questions.  "Is it extended release"  "Does it contain or is it in the family of NSAIDS"  Along with other questions "I am on x y and z for the other things, will this interact with it"  Oh - and as an aside....this also means you need to know the doseage and name of every drug you take.  Preferably WRITTEN down in your wallet.  Why?  When you KNOW them?  Because you can't talk when you are unconscious.  And the info in your brain does me little good in a emergency because my mind reading abilities are a bit off lately.

Ok...I'm off my tangent :)

Pam, I love your tangent!

My husband was an EMT for a while, and my son is a paramedic. Both empahsize the importance of a Medicalert necklace or bracelet - NOT JUST A CARD IN YOUR WALLET. To quote them both, somewhat graphically,  "When we pick someone up of the highway with a stick and a spoon, we don't look in their wallet first."

They DO notice the alert jewelry though..

And DO keep a list of medications and vitamins. My mom does this, as well as her allergies, and I have had to refer to it more than once when taking her in to the ER.

All of my Drs have a list of the "approved" drugs that Barix had given me. I always ask too if it is an NSAID, extended release, OK for baby etc. I again ask the pharmacist when I pick it up if it is OK or not.

I take my multi vite, B12, calcium, folic acid religiously. I'm not saying I haven't forgotten from time to time but I Do pretty darn good considering!

Pam,

It's a very timely (and sobering) reminder that we can't allow ourselves to become complacent.

We've had discussions a few times at Barix support meetings about the need to proactively inform (and remind) your doc AND your pharmacist about the malabsorption issue.  Combined with the critical need to have AND WEAR medical alert jewelry.  

Medicalert.org is the website for the Medical Alert Foundation - a nonprofit foundation that supplies medical alert jewelry (runs $9.95 and up - certainly within most people's budgets, so that's no excuse).  You can also choose to join for $40/year (again - cheap) and they will maintain your medical records in their databases, keyed to an ID number on your jewelry.  The hospital can call and find out what meds you are on, who to contact, who your doctors are, and who your insurance company is, in addition to any allergies, conditions, or other things they need to be aware of.

So for example my tags say "Gastric Bypass. Do not blindly place NG tube. Codeine Allergy. XXXXXX" (the XXX is my id number.  The tag has everything critically needed right up front, then the resource to help them get the rest.  It doesn't say "no oral nsaids" because by definition if I'm taking something orally, I'm awake.  But that notation does exist in the online database.

I also have an app in my cell phone called "ICE" (in case of emergency) - it holds basic info like my doctors, who to call, drug allergies, drugs / vitamins and dosages, insurance info, and condition info (called "alerts).  It can be accessed by a paramedic or doc, and my understanding is that coding numbers as "ICE - doctor" or "ICE - husband" in your cell phone is a standard way of communicating that info that they're trained to look for.

We have to be responsible for our own health and our own self-care.  This is an easy way to do it.

Karen

Wow!  This is some great info.  I am scheduled for surgery on 3/30 so every bit of info I can get helps so much.  For Pam, I am a nurse also and I agree with you.  Patients are sometimes poor historians when it comes to THEIR health.  They think we have a mainframe and all docs, nurses and hospitals automatically know your information.  They dont know names or dosages and sometimes will only know the doc gave them " a pill for infection".  They cant tell you what kind of infection, the name of the med or anything.  Secondly, I have gone to meetings, talked to many bariatric patients and in a year or two, they are slacking on taking their supplements.  I also notice how many, not all, dont go to support meetings anymore and some dont know anything about this site. It just lets me know how connected I need to stay to the basics.  I dont want to get away from what I call "the absolutes" of WLS.  I am getting my absolutes together and it will become and remain my WLS Bible.  Im doing this surgery at 50 at I dont want to do anything that will compromise my recovery, my honeymoon period, or my longterm success.  Being here and going to meetings keeps me present to just what a lifestyle change this really is and not just to lose weight but forever.  As a side, Im not in la la land about the journey.  Im prepared for the ups and downs but I want to stay mindful not to be in my own way.

Great information.

I saw my endocrinologist a week after surgery, to tidy up my diabetes plan, and he didn't know that I wouldn't be able to take extended release meds any more.  And this is a guy who has always impressed me with how knowledgeable he is about the latest journal articles, etc.  It's impossible for them to read and know everything, so we have to be responsible for knowing everything that pertains to US.

Thanks for posting this!

Elizabeth