Posted by: Gillham21 July 2014
It seems there are alternatives to bariatric surgery.
My patient wobbled in, breath heavy from a recent fag. The numbers weren’t encouraging: BP 162/94 (from stringent home BP monitoring), BMI 38. His recent bloods gave him a diagnosis of type 2 diabetes. At 72, his QRisk made him odds on for imminent cardiovascular catastrophe. In terms of risk-profiling, this man had a full house.
In an effort to motivate change, I painted a bleak picture, and we negotiated a plan. He would lose the weight, which would help his blood pressure and the diabetes. He’d lost weight years ago, several stone in fact. He was pretty sure he could do this again. He was not prepared to stop smoking.
He knew about carbohydrates and proteins. He understood his calories. Target set at 1000 kcal/day, I would see him again in three months. As he left, I wondered if I’d ever see him again. With patients like this, especially after a blunt chat, you worry about disengagement.
But last week, he came back in. Some 15 months had passed since we’d last met. His numbers are better, more than likely helped by the seven stone he’d lost: all due to calorie-counting, not cancer. His BP was low, so I stopped his anti-hypertensive. With an HbA1c of 32, he has come off the diabetic register.
We shouldn’t have favourite patients, of course, but he is one of mine.
No Weight Watchers, no Xenical, no LighterLife. No gimmicks, no faddish soups, no gastric band. Just self-motivation, and the realisation that his lifestyle was slowly killing him.
Though he’s drowning in his jumper, he hasn’t bought himself any new clothes. He just doesn’t see the point (and anyway, he needs the cash for his nicotine habit. But he’ll tackle that next).
Bariatric surgery: £7,500 and a few nights in the HDU.
Frank consultations with motivated patient: £7.50, and more energy than he’s ever had.
Dr Tom Gillham is a GP in Hertfordshire and specialty doctor in A&E. You can follow him @tjgillham.