Supplements for men
WLS 11/27/06 Lap RNY
379/ 313/ 173/ HEALTHY !!!Highest/Surgery/Current/Goal
"Just because you CAN, doesn't mean you SHOULD"
Living in Beautiful Sunnyvale California, via Arkansas (Go Hogs) via Washington State, via born and raised in Oregon.. What a journey..
Debbie, I'll try to past in some stuff from a survey I presented at the recent Lexington conference, It will probably take several posts, so bare with... Best Wishes- Dx Survey Report of Male/Female Differences As Regards to Aspects of Bariatric Surgery: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: This Survey attempts to give clearer understanding of the Aspects of Bariatric Surgery which may be unique for the Majority of Men. General Information- 68 responses to the questionaire were obtained. Although State addresses were gathered, in an attempt to maintain full confidentiality, State/City locations of respondents has been Withheld from Report. (All replies are confidential and will be used only in compiling a database of "Anecdotal Observations.")
Answers Provided by- Dr.? ---- 46 Clinic Representative? ----- 22 Types of Bariatric Procedures Performed- (of the 68 respondents, most checked multiple procedures) RNY Open 67 / RNY Lap 63 / Lap-Band 44 / DS 3 / VBG 26 *Other 8 (*Specified as variations on DS, RNY, VSG, or Revisions)
Rough approximation of number of procedures a year 148-Average (Number of surgeries ranged from 60 to 250+)
Roughly two-thirds of the respondents were direct replies from surgeons. Approximately one-third of the responses were filled out by Surgical Clinic Directors, Nurse Assistants or Surgical Clinic's Staff Member.In response to "Types of Bariatric Procedures Performed," most respondents included procedures they "had performed" whether they presently offered that procedure to patients or not. This would seem to account for the large number of ‘Open RNY’s’ and ‘VBG’s.’ :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: In order to assess the overall Male/Female Ratios experienced by the respondents, the following information was also obtained: What percentage of your patients are Male? – (or estimation, check one-) (Given estimations ranged from 8% to 27%) Less than 10%- 12 respondents 10% to 20% - 52 respondents 20% to 30% - 4 respondents 30% to 50% - 0 respondents More than 50%- 0 respondents The typical range of 12% to 19% that is seen nation wide was supported by this survey. Due to the "___% TO ___%" range type of question, no exact percentage was sought. :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: The Following 10 Questions were derived from Weight Loss Surgery Message Boards. Often repeated assumptions were "checked" against the observations of Surgeons and Clinicians in an attempt to dispel or support patient observations shared on the internet. To each of the following questions the respondents were only able to answer as----- Strongly Agree------ (6) Somewhat Agree---- (5) Agree----------------- (4) Disagree-------------- (3) Somewhat Disagree- (2) Strongly Disagree--- (1) No Observation------ (0) (Additional percentages were asked for directly comparing Men with Women as regarding the specific issue of theQuestion.) Each Question permitted and requested "additional or specific examples." Several of the Surgeons and many of the Clinicians offered additional information to every question. If an example is either noteworthy or was repeated enough to make it standout as being ‘Typical,’ reference to that ‘additional information’ has been included in the following. (more to follow...)
(question #1) Compliance to Doctor’s Protocol: _____ 1.) A Larger percentage of my Male patients are Less Compliant with Dietary Protocols Than my Female Patients. approx. % of Men with Compliance issues? ------- [10% Average]approx. % of Women with Compliance issues?----- [18% Average]Strongly Agree------- [ 0 respondents] Additional Information:
Somewhat Agree----- [ 4 respondents] Agree------------------ [ 7 respondents] Disagree-------------- [ 34 respondents] Somewhat Disagree- [ 15 respondents] Strongly Disagree--- [ 2 respondent] No Observation------ [ 6 respondent] (Men, as a rule, tended to follow "Dr.’s orders" well, to an extent, but were more more likely to discontinue follow-up appointments.) (Three different Dr.’s gave nearly a verbatim account of the "compliance issue" for Men being one of not returning for follow-up visits. Six of the surgeons made mention of Men not returning after their 6th month check-up either due to relocating or simply failing to continue the scheduled visits.
As for "Compliance," the majority of the respondents referred primarily to patients not following dietary recommendations, vitamin and supplement directives. Problems adhering to diet and supplement recommendations accounts for the overall higher percentage of Women showing ‘compliance issues.’ These issues were notably more prevalent among women, but as one doctor pointed out- "…It’s difficult to know about some of my male patients, because they just stop coming for follow-up appointments.") (more to follow...)
Exercise: _____ 2.) A Larger percentage of my Male patients are more Motivated towards Exercise than my Female Patients..
approx. % of Men adopting or showing interest in increased Exercise? ----------- [80% Average] approx. % of Women adopting or showing interest in increased Exercise? ----------- [40% Average]
Strongly Agree------- [38 respondents] Somewhat Agree----- [18 respondents] Agree------------------ [ 7 respondents] Disagree-------------- [ 1 respondent] Somewhat Disagree- [ 0 respondents] Strongly Disagree--- [ 0 respondents] No Observation------ [ 4 respondents] Additional Information: *(Men, tended to talk about their exercise programs more than the female patients. They seemed to enjoy the new found exercise regimens, beyond just walking.)
(Overwhelmingly the Doctors and Clinic Directors observed their male patients "actively enjoying" exercise as part of their "New Lifestyles." Four of the respondents had no interaction with their patients with regard to exercise and could offer no insight. One surgeon who disagreed, was also one of the surgeons that had the lowest percentage of male patients. Eight of the respondents included that their male patients were most likely to ask –"When can I Lift, Swim, begin at the gym, etc…." They indicated that the male patients initiated exercise programs prior to being encouraged to do so.
Rate of Weight Loss to Goal: _____ 3.) A Larger percentage of my Male patients reach "Goal Weights" sooner than my Female Patients. approx. % of Men reaching "Goal Weights" sooner than expected/planned? --------- [61% Average] approx. % of Women reaching "Goal Weights" sooner than expected/planned?------ [6% Average]
Strongly Agree------- [34 respondents] Somewhat Agree----- [17 respondents] Agree------------------ [15 respondents] Disagree-------------- [ 0 respondents] Somewhat Disagree- [ 0 respondents] Strongly Disagree--- [ 0 respondents] No Observation------ [ 2 respondents] Additional Information: * (Since Men often lose weight faster than female WLS Patients, some Doctors may set higher goals and expectations of their Male Bariatric patients.)
Nearly all respondents agreed to various degrees that "Men just lose faster than Women." This question, prompted many additional comments. Most Doctors felt it necessary to explain that- "Men have higher percentage of muscle mass…thus have a higher ‘resting’ metabolic rate." "Women have more stalls in weight-loss due to hormonal cycles…" "Initial rate of weight loss is less important than continued change of life-style…"
Several Doctors found it necessary to clarify the ambiguity of the phrases- "Sooner than expected/planned," and "Goal Weights." Five of the respondents claimed that they regularly set expectations for their male patients much higher than their female patients.
Maintenance of Weight Loss Goals:
_____ 4.) A Larger percentage of my Female patients Maintain "Goal Weights" Better than my Male Patients. approx. % of Men who Maintain "Goal Weights?" -----[80% Average]approx. % of Women who Maintain "Goal Weights?"---[78% Average]
Strongly Agree------- [ 2 respondents] Somewhat Agree----- [15 respondents] Agree------------------ [ 9 respondents] Disagree-------------- [ 8 respondents] Somewhat Disagree- [ 1 respondent] Strongly Disagree--- [ 0 respondents] No Observation------ [ 33 respondents] Additional Information: (Men, present difficulties when trying to assess long term maintenance of "goal weights," due to low rate of follow-up care.)
(This question tied directly to the "compliance issue" for many of the Doctors. Men tend to present a problem by not returning for follow-up visits. Several staff members who were engaged in their local support group stated that "…the men, who continue coming, seem to be very successful at maintaining their weight-loss, but many just stop checking in." Many of the respondents "qualified" their answer to this question by including- "as of the last visit/appointment…"
Once again from the Doctors-
"…It’s difficult to know about some of my male patients, because they just stop coming for follow-up appointments.")
Calcium Levels:
_____ 5.) A Larger percentage of my Female patients have difficulty with Calcium Levels than my Male Patients.
approx. % of Men having difficulty with proper Calcium Levels? --------- [5% Average] approx. % of Women having difficulty with proper Calcium Levels?------ [20% Average]
Strongly Agree------- [39 respondents] Somewhat Agree----- [10 respondents] Agree------------------ [17 respondents] Disagree-------------- [ 0 respondents] Somewhat Disagree- [ 0 respondents] Strongly Disagree--- [ 0 respondents] No Observation------ [ 2 respondents] Additional Information: (Women were perceived as having more difficulty getting appropriate and adequate Calcium in their diets regardless of the challenges related to WLS.)
(Nearly all respondents agreed to various degrees that "Men have far fewer Calcium related problems than Women." This question did prompt many respondents to add that "Men are not exempt from needing to supplement Calcium." The consensus was that the Female metabolism utilizes Calcium differently for several reasons. In addition to "Calcium Needs" being un-equal, the body's calcium balance and bone density can also be affected by the hormonal cycles, physical activity, Vitamin D (from food or formed by skin under the influence of sunlight) and general food and beverage intake. For many, these factors may be different in men and women, i.e. exercise, sun exposure, etc. It’s not just the difference in the hormones, but some is the intrinsic usual differences in lifestyle.) (more to follow...)
Iron Levels:
_____ 6.) A Larger percentage of my Female patients have difficulty with Iron Levels than my Male Patients.
approx. % of Men having difficulty with proper Iron Levels? --------- [5% Average] approx. % of Women having difficulty with proper Iron Levels?------ [26% Average]
Strongly Agree------- [39 respondents] Somewhat Agree----- [12 respondents] Agree------------------ [15 respondents] Disagree-------------- [ 0 respondents] Somewhat Disagree- [ 0 respondents] Strongly Disagree--- [ 0 respondents] No Observation------ [ 2 respondents] Additional Information: (As with Calcium, Women tend to have more Iron needs prior to any form of WLS. Men typically no problems getting appropriate Iron levels from diet alone.)
(Nearly the same response as with the Calcium question with a few notable different remarks. "For women, the RDA for iron is 15 milligrams per day, 5 milligrams more than the RDA for men. Women need more of this mineral because they lose an average of 15 to 20 milligrams of iron each month during menstruation …. After menopause, body iron stores generally begin to increase. The incidence of iron deficiency in women over 50 is approximately the same as with Men." One of the respondents added that "…Men may have less Iron problems because they seem to choose to eat more red meat later Post-Op. A lot more Women seem to complain about not liking beef, but the guys seem to add it back into their diets more than some of the women." There were also multiple comments reminding that "Many Men after having an RNY, may need to supplement their Iron." )
General Nutrition / ‘Lab-Work’ Mal-Absorption :
_____ 7.) A Larger percentage of my Female patients have some difficulties with Nutrition / ‘Lab-Work’ in general than my Male Patients..
approx. % of Men who have needed to adjust supplements for Mal-Nutrition? ----[19% Average] approx. % of Women who have needed to adjust supplements for Mal-Nutrition? ----[30% Average]
Strongly Agree------- [ 7 respondents] Somewhat Agree----- [ 7 respondents] Agree------------------ [ 11 respondents] Disagree-------------- [ 9 respondents] Somewhat Disagree- [ 3 respondents] Strongly Disagree--- [ 3 respondents] No Observation------ [ 28 respondents] Additional Information: (Men, need to be more serious with their follow-up visits, but generally do a good job of staying on top of blood work & vitamins.)
(This question prompted several Doctors to once again ‘scold’ Men in general for failing to maintain follow-up appointments after the first year. Men may have un-diagnosed mal-nutrition issues later because they didn’t feel it necessary to have their blood checked. However, the "Missing Men" aside, most respondents observed that the Men who did follow appropriate follow-up schedules, showed a much lower incidence of Mal-Nutrition than their female counterparts. Three staff members made very similar observations that -Many Men, particularly older Men with a pre-existing health problem, have their own personal nurses- their wives. "Honey it’s time for your pill…" is very typical in older couples. It was also noted by several that men tend to take their as vitamins regularly and seriously as they would their Blood Pressure medication. This was contrasted by the observation that Women may stop taking vitamins regularly when they "Feel Fine." It was also noted by multiple respondents that older, married Men were less likely to skip their Vitamins, than younger, single Men.)
Educated about Bariatric Procedure:
_____ 8.) A Larger percentage of my Female patients take a more active role in educating themselves about the Bariatric Procedure than my Male Patients.
approx. % of Men Actively self-educated about WLS? ----- [80% Average] approx. % of Women Actively self-educated about WLS?-- [88% Average]
Strongly Agree------- [ 0 respondents] Somewhat Agree----- [ 6 respondents] Agree------------------ [ 19 respondents] Disagree-------------- [ 17 respondents] Somewhat Disagree- [ 5 respondents] Strongly Disagree--- [ 1 respondent] No Observation------ [ 20 respondents] Additional Information: (Women were perceived as slightly ahead of the Men in this area, the level of education about WLS on the whole, was seen as very high.)
(The majority of respondents commented that as a group, All Bariatric patients were very active in researching WLS. Several mentioned that they worked with various non-Bariatric patient groups and that by far, patients that were seeking WLS came in from the beginning with more information than any other patient base. Female patients were observed to be slightly ahead of the Men in this area. Perhaps connected to the overall general familiarity with Doctors in general? Very few respondents offered additional explanation for their perceptions on this question. One staff member did comment that- "The women are more open and talkative in pre-op meetings and seminars." )
Co-Morbidities Prior to WLS:
_____ 9.) A Larger percentage of my Female patients present more Co-Morbidities Prior to Surgery than my Male Patients.
approx. % of Men with Co-Morbidities prior to WLS? --------- [91% Average] approx. % of Women with Co-Morbidities prior to WLS?------ [66% Average]
Strongly Agree------- [ 0 respondents] Somewhat Agree----- [ 1 respondent] Agree------------------ [ 4 respondents] Disagree-------------- [ 19 respondents] Somewhat Disagree- [ 5 respondents] Strongly Disagree--- [ 36 respondents] No Observation------ [ 3 respondents] Additional Information: (Women appeared to have less Co-Morbidities associated with Obesity prior to seeking WLS. Hypertension appears to be very common problem for obese Men.)
(Overwhelmingly the respondents observed that Men had more Co-Morbidities present prior to WLS. This question prompted many to mention specific health problems. Hypertension was noted as the number one problem, followed closely by sleep apnea, diabetes mellitus type II, and cardiovascular disease. Three staff members had very similar observations that "…most Men wait until their health is in danger before seeking to treat their Obesity." A combination of Staff and Surgeons added that many of their Women patients became interested in WLS either on their own or due to a female relative or friend having the surgery. This was contrasted by the observation that many of the male patients either sought WLS due to urging from a spouse or Primary Care Physician. Multiple respondents also offered the observation that many of their male patients were in over-all worse health than their female patients prior to surgery.)
Post-Operative Complications:
_____ 10.) A Larger percentage of my Female patients experience post-operative Complications than my Male Patients.
approx. % of Men with Post-Operative Complications? --------- [3% Average] approx. % of Women with Post-Operative Complications?------ [4% Average]
Strongly Agree------- [ 0 respondents] Somewhat Agree----- [ 2 respondents] Agree------------------ [ 20 respondents] Disagree-------------- [ 22 respondents] Somewhat Disagree- [ 12 respondents] Strongly Disagree--- [ 1 respondent] No Observation------ [ 11 respondents] Additional Information: (Women appeared to have less Surgical complications, yet more long term Nutritional issues than the Men. Both have low rate of complications in general.)
(This question, more than any other, prompted additional comments and clarifications. Many of the surgeons included the explanation that "Post-Operative Complications" should be separately regarded as-
- Surgical Complications (which they reported as very low)
- Longer term Nutritional Complications (which also were reported at low percentages) and lastly,
- Complications that included- regain of some of the lost weight, Plastic Surgery needs, Skin issues that required Dermatologist and/or Plastic Surgery, Hernias, and Post-Op depression, etc….
Every respondent providing a response of "Complications" at a percentage higher than 2%, included a "clarification" so as to include a whole range of potential complications. When breaking out the comments and explanations, it was clear that Women were observed as having more skin issues and nutritional issues, and Men were more likely to have Surgical Complications. Several of the respondents commented that a higher percentage of their male patients were in a higher risk category prior to surgery and that this accounted for the higher percentage of surgical complications among Men. Six of the respondents offered the information that Men tended to have larger livers and/or undiagnosed non-alcohol related fatty liver disease.(NASH, or nonalcoholic steatohepatiti) Two of the Doctors who offered the "fatty liver" information, also included the observation that more of their male patients may have some history of alcohol use at a higher percentage than their female patients.
Four of the Surgeons stated that they observed lower percentages of Women with Obstructive Sleep Apnea when compared to their male patients.
Several respondents included some explanation that Men tended to carry their excess weight on the abdomen, thus making laparoscopic procedures more challenging. One Surgeon included that they have found it necessary with 3 of their male patients, to do multiple or "Staged" surgical procedures in order to reduce the pannus in a preliminary surgery and perform the Gastric Bypass procedure as a second surgery. This same Surgeon also offered the information that in cases of extreme morbid obesity, a vertical sleeve gastrectomy prior to a gastric bypass may be warranted to reduce surgical risk.
Four of the respondents offered information about the effectiveness of insertion of a Vena Cava Filter in patients prior to the WLS. Two of these respondents, along with several others singled out Men as having more risk of Deep venous thrombosis (DVT) and pulmonary embolism (PE) associated with surgical procedures.
From the range of comments and responses to this question, it was clear that it was a "hot-button" issue, and that the wording of the question was too ambiguous and inclusive to produce a clear numerical response.)
Targeting Men: Areas that Men Can Improve On,
Based on these Observations:
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In order of "Most Observed/Reported," Men can make improvements in how they approach the WLS Process in the following areas-
1.) Increase Commitment to follow-up appointments and continued monitoring of progress through surgeon’s office.
Long-term success can be best achieved by utilizing the continued input of the Bariatric surgeon and the protocols that each particular surgeon’s off ice has in place. Problems that may arise from long-term mal-absorption of nutrients may be prevented before it becomes an issue, by simply adhering to the Doctor’s plan. If you are one of the Men who have discontinued making appointments to see your Bariatric Surgeon. You may have much to gain by setting up a system of check-ups and being as vigilant with your own "preventative maintenance" as you are with changing the oil in your car.
2.) Utilize Support Groups and make a complete attempt to get all of the benefits that your local support group has to offer.
Statistically, people who continue attending support groups after Bariatric procedures show greater long-term success rates. Men often complain - "I don’t get anything out of my support group." Then take it upon yourself to change the make up or manner of your local support group so that it serves your needs. "No Man is an Island." Perhaps establish your own "buddy-System" with other Men in your area to have a system of accountability in place to further your exercise habits, nutritional concerns, even relationship problems. It’s easy to see that having "drinking buddies" is a sure-fire way to make sure you continue drinking. The same is true of WLS support. Hanging out with guys, who share a common bond of working to increase long-term health, naturally makes attaining that goal easier.
3.) Work toward Better Communications with your Physicians.
Overcoming hesitancy or embarrassment and talking openly and honestly with your Doctors can make a huge difference in the care you receive. The Stereotype of "Men not asking for directions" may be fine when driving, but when it comes to health issues, why not get your complete money’s worth? Taking the initiative and directly communicating your thoughts, concerns and questions with your physician, promotes more reliably accurate diagnosis and care.
4.) Do everything possible to improve pre-op health to reduce surgical complications.
Knowing that most Men have greater health issues prior to surgery, and that those can translate to statistical likelihood of complications, should be a clear signal to step up pre-op precautions such as-
1.) Losing weight prior to surgery to reduce liver size, 2.) Stopping Smoking and not "sneaking a few puffs" prior to surgery, 3.) Being completely open and honest with physicians regarding alcohol use, or any other activity that could compromise your complete success during and following surgery.
5.) Work to prevent Hernias.
Knowing that Men have a greater propensity to develop hernias Post-Op, it makes sense to take extra precautions to avoid them. Even though an abdominal binder may be the most uncomfortable garment ever worn, wear it, or order another one that is of a higher quality and designed for extended wear. Do not rush to return to lifting and working as usual. Just because you are feeling better, if the Doctor has not cleared you for lifting, treat that recommendation as a law, not just a suggestion.
6.) Take Full Advantage of the Benefits of your Male Physiology.
Since Men tend to lose faster due to muscle mass, make the most of your weight loss while it is easy and plunging down the scales. Work to retain as much of that muscle as you can so it will continue serving as a metabolic furnace once you are at or near "goal weight." Younger Men take a lesson from the old guys-
"Take your Vitamins like your Life depends on it." Because it does!
