After Care and Low A1C

Hi Everyone

I am in need of some help on two things. First off, I am extremely frustrated trying to find a doctor for my after care. I moved to Southwest Florida (***** Gorda) area about 7 months ago. I had my surgery done in Delaware. My surgeon told me they couldn't continue my aftercare since I moved. I had asked if I could still get my blood work ordered from her and just review it on the phone. They said I need to find another surgeon. My work provide a free clinic for everyone for just primary care. I've gotten them to order test but feel like they don't know how to really handle any issues I am having. I did find a local surgeon that does Traditional DS. Their office said I don't require a surgeon's care and denied to see me.

So which is it? I was told early on to always have a surgeon and follow at least once a year with them. Do I need one or not? If I don't does anyone living in the SW Florida have a good primary doctor they can recommend that understand our surgery. If one more person refers to me as a bypass patient I am going to scream.

Now the real question, that I need help with and why I am search for a doctor. So I've had my blood work done twice now. My one year anniversary for traditional DS was 9/27. Both times my A1C has come back below normal. The first time it was below 4.2 after several verified analysis. The doctor felt it was a mistake and said we will see what it is the next time. The next time was 4.3. My fasting glucose was 82 and this past time 72. Is this OK? Has anyone else dealt with this.

My biggest concern was last week for the first time I tried exercising in the morning instead of in the evening. I was fine but then at the end got extemely lightheaded and everything was foggy. I ate and it didn't go away. After two days I went to the clinic and they didn't know what to do. They decided maybe it was blood pressure since my at home blood sugar test at the lowest have only been 85 but mostly stay in the 90's. So they took me off my meds, things have gotten a bit better but now I've gained 8 pounds in a week. Some of it I know is water but some could be because I decided to up my carbs to see if that help.As I was thinking maybe I've been too low.

Anyways I am rambling. Any advice on Doctors or the labs would be welcomed.

I think the aftercare is important, but not super critical with the same surgeon. I'd find a local support group and try to join in. We have many people in our group who've moved and had surgeries elsewhere. Then I'd try to find good doctors who know bariatrics. My endo and vascular surgeon were surgeon recos and they are fantastic. Maybe you can find a good surgeon's practice manager - discuss your situation and find a good primary care and endo they would recommend. They can then do your bloodwork and aftercare. But a support group and ask the patients or the sponsor for your in-plan options (recommendations for those they'd send their patients to). Good luck

Surgeons are cutters. You don't need a surgeon. Some of the DS surgeons run aftercare programs and follow their patients for life. Others do not. After you have recovered your relationship with them is done. In your case, you moved. You need a doctor who is willing to learn about the DS to properly manage your ongoing needs.

On to your A1C. You were just taken off your diabetes meds. Right? If that's the case, get tested again in 6 weeks to see where you are. They may have waited too long to take you off the meds.

Thank you for replying back. The kicker is I was never on any diabetes medicine. I never have been. I decided to do my surgery before I got to that point. My reasons were more preventative out of concern for my family history of heart and diabetes issues. The highest it ever was before surgery was 5.1 So this drop has only happen since surgery. Outside of having High B12, all my other labs are good except for the A1C.

I suppose maybe this is my new normal. I am not sure. The clinic doctor doesn't seem concern. My fasting glucose was 72. 6 months before that was 82. I just don't want to take a wait and see approach if am headed in a bad direction and could prevent it ahead of time.

I'll keep searching for a doctor that will actually listen and read the material I give them.

Agreed with others - surgeons cut and then they are done. Just find a knowledgeable PCP that has a little bit of understanding of wls. They will refer you to various doctors depending on your specific medial needs - same thing a surgeon would do if they had follow-up visits.

My glucose fasting is usually in the 65-73 range. My glucose after a high carb meal never topped 95. (I was pregnant and tracked for a week). My surgeon team was never concerned.

If I don't eat within 2 hrs of waking I get light headed and dizzy. I eat every 2 hrs, I eat right before bed (protein shake).

Id keep an eye on it but I wouldn't be concerned.

Normal A1C is 5.0 - 5.5. There is nothing wrong with being a bit lower. Glucose around 90 is also normal. You don't need a surgeon, just a primary care.

I moved to Venice, FL a couple years ago. I am 20 years post op and still get regular/annual checks. I see Dr John Southerland in Sarasota.

Teresa

I've had my PCP handle all bloodwork for about 13 years. The suregeon's staff was about as knowledgeable as any other doc about nutrition, really. The DS is a mystery to most medical professionals. Even nutritionists and dieticians don't get it.

What you need is a PCP that is curious enough to partner with you to find a good balance and adjust as needed. I find best luck with younger docs. Bring your PCP information (printouts, links, and especially a diagram) of the DS to keep in your file. Also provide them with the list of annual labs. Don't count on your PCP doing all of the work with knowing your levels. Learn how to read your test results and insist on keeping a copy so you can compare with the last time and catch new trends and make adjustments. The docs aren't so good at that.

My surgery was years ago. My A1c is usually 3.9 to 4.2. No idea if it is normal. But I never have symptoms.