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.

Is discontinuing her medications realistic? Explain..

Answer 1

Patient body mass index is more than 35kg/meter square.It idicates severe obesity and is a serous health problem with significant comorbidity and impairments in quality of life.I would tell her that bariatric surgery is most efective for severe obesity (will result in significant weight loss) as well as will help tp improve in diabetic problems(type-2) .It will also help to enhance physical functioning and quality of life. I recommend her a high aerobic exercises before surgery because it will help toreduce the operative complications ,as well as help to get a speedy recovery. I would recommend bariatric surgery might help her to reduce the glucose level,and abnormal cholesterol level.However it is not wise to stop the medicines abruptly.She will have to under go continous monitoring in order to stabilise her   bloodpressure and glucose levels.A proper diet control and exercise regimen will help to achieve controlled hypertension and diabetes.I will notify her about the consequences of pre and post exercise programs as the patients may feel tiredness and dizzy due the medications.I also recommend her to check with her cardiologist to minimize the the risk for attack or stroke before starting exercises.As she suffers arthritis ,she needs to be referred to the physiotherapist to learn rehabilitative exercises (risk for injury).