Question

You are working at a bariatric center and a patient comes to you for pre-operative exercise counseling. Your role is to assess and counsel/ prescribe patients on exercise prior and post-surgery. With this, each patient must participate in at least 8 weeks of an exercise program prior to surgery. (10 points)

Patient Profile: the patient is 48 years old, weight is 345 pounds; BMI= 57 kg/m2. She had a recent oral glucose tolerance test result of 285 mg/dl, TC= 290 mg/dl; TG= 560 mg/dl; HDL = 19 mg/dl. She also has sleep apnea and is developing arthritis in both knees. She takes 120 units of Lantus (basal insulin); 25 units Humalog (rapid insulin) per 3 meals; 80 mg of Zocor; 100mg Atenolol; 1500 mg Niaspan and Valsartan 160 mg twice daily.

Her goal with the laparoscopic adjustable gastric banding surgery is to lose 200 pounds and discontinue all her medications. She is getting the surgery so she does not have to try another diet and fail. She also hates to exercise so having this surgery will help her avoid exercising to lose weight. However, she realizes that she has to comply with your 8 week program to get the surgery.

a. Is a 200 pound weight reduction goal with the lap band realistic? Explain.

b. Is discontinuing her medications realistic? Explain.

c. The doctor never explained why she is taking the meds that she is. She asks you what her meds are for (what condition), why she needs her medications and what specifically they do to help her. Explain all the med’s mechanism of action.

d. Using the Stages of Change Behavior Theory, what is this patient’s current stage?

e. Using the FITT principle, what would your exercise plan look like? Do we need to be concerned with the medications regarding exercise induced responses?

The patient came to your exercise sessions 80% of the time during the 8 week period. Since she only needed to comply by 70%, she was granted the lap band surgery. After 12 weeks, she has lost 50 pounds and has eliminated her insulin and cholesterol medications but is still on the hypertension meds. Her knees also are starting to feel better. You meet with this person post-surgery for an exercise assessment and the post surgery program. This time, she is very resistant to your exercise advice. In fact, she has no interest in participating in your exercise program anymore.

d. Was this behavior expected? Why or why not?

e. Using the Stages of Change Behavior Theory, what is this patient’s current stage now?

f. What might this patient need to progress to the action stage? To answer this, describe how you would approach the patient through each stage leading to ACTION.

g. What would you tell this patient regarding the importance of exercise post-surgery despite the large reductions in bodyweight?

*This is all the information that was given*

Answer 1

Answers :

a.) Is a 200 pound weight reduction goal with the lap band realistic? Explain.

• The average weight loss for Lap-Band patients, in total, is 50% of excess weight. To calculate excess weight, take your current weight and subtract your ideal weight (or weight at a healthy BMI)
• It is possible to get down to your ideal weight following gastric banding. Most patients lose about half of their excess weight following gastric banding, and they lose it slowly and steadily, about one to two pounds per week.

b.) Is discontinuing her medications realistic? Explain

• In the current study of more than 30,000 patients, the researchers focused on rates of antidiabetes medication usage up to 6 years after bariatric surgery, finding that those patients who had the procedure were at least four times more likely than control patients to discontinue treatment for diabetes.
• The doctor never explained why In the current study of more than 30,000 patients, the researchers focused on rates of antidiabetes medication usage up to 6 years after bariatric surgery, finding that those patients who had the procedure were at least four times more likely than control patients to discontinue treatment for diabetes.

c.) she is taking the meds that she is. She asks you what her meds are for (what condition), why she needs her medications and what specifically they do to help her. Explain all the med’s mechanism of action.

The med’s mechanism of action.

• 20 units of Lantus (basal insulin); 25 units Humalog (rapid insulin) per 3 meals
• · The primary activity of insulin, including insulin glargine, is regulation of glucose metabolism. Insulin and its analogs lower blood glucose levels by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production.
• · Rapid Acting Insulin Analogs (Insulin Aspart, insulin Lyspro, Insulin Glulisine) which have an onset of action of 5 to 15 minutes, peak effect in 1 to 2 hours and duration of action that lasts 4-6 hours.

80 mg of Zocor :

• Simvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

100mg Atenolol :

• Atenolol belongs to a class of drugs known as beta-blockers. It works by blocking the action of certain natural chemicals in your body, such as epinephrine, on the heart and blood vessels. This effect lowers the heart rate, blood pressure, and strain on the heart.

1500 mg Niaspan :

• The mechanism by which niacin alters lipid profiles has not been well defined. It may involve several actions including partial inhibition of release of free fatty acids from adipose tissue, and increased lipoprotein lipase activity, which may increase the rate of chylomicron triglyceride removal from plasma.
• Valsartan 160 mg twice daily.

Mechanism of Action :

• Valsartan blocks the vasoconstrictor and aldosterone-secreting effects of angiotensin II by selectively blocking the binding of angiotensin II to the AT1 receptor in many tissues, such as vascular smooth muscle and the adrenal gland.