Complications from Gastric Bypass surgery include death, bleeding, Pulmonary Embolism, and battling addictions. The latter may form the basis for a Medical Malpractice Claim, If a doctor fails to evaluate a patient’s addictive tendencies, and fails to provide the patient with an informed consent of the risks and complications of Gastric Bypass Surgery.
As reported by the Sun Sentinel, swapping one addiction for another is common among gastric-bypass patients, who struggle more than the general population with issues of addiction.
Patients who undergo gastric-bypass surgery are four times more likely to require inpatient care for alcohol abuse than the general population, according to a study presented last month at the Digestive Disease conference in Chicago.
The study, which followed 12,277 bariatric surgery patients over 25 years, also found that gastric-bypass patients were more at risk for abusing alcohol than those who had restrictive procedures, such as banding
Marty Lerner, a psychologist and clinical director of Milestones in Recovery, a residential-eating-disorders program in Fort Lauderdale, sees many patients who’ve transferred their food addictions to other substances or behaviors.
“Alcohol and drug dependencies are the most common,” he said, “followed by compulsive shopping and sex addiction.” In every case, people are substituting one form of self-medication for another.
“All addictions are about fixing how one feels,” said Lerner. “Changing the nature of the addiction does not change the nature of the person.”
So far the most-studied of these transferred addictions is alcoholism.
The reasons for the addiction transference are both psychological and physical, say experts.
Because gastric-bypass surgery causes food and drink to move past the stomach and directly into the small intestine, alcohol hits patients faster, said Magdalena Plecka Ostlund, lead researcher on the study conducted at the Karolinska Institute in Sweden.
“The alcohol enters the small intestine rapidly, which results in a high and quick peak of alcohol in the blood,” she said.
The other driver is mental. “When you take away someone’s primary addiction, in this case food, they often need to build their world around something else,” said Dr. James Mitchell, chairman of neuropsychiatry at the University of North Dakota School of Medicine.
For Sue Jacobsen of Long Island, N.Y., that something else was alcohol.
Jacobsen, a 47-year-old, 5-foot-8-inch, public-relations consultant who quickly went from 275 pounds to 167, had her first cocktail three months after her surgery. That was the brink of a slippery slope.
She started drinking more, and within a year was drinking often with friends. “When I did, I would get blitzed.”
Soon she couldn’t go a day without drinking. Blackouts were common. “I’d wake up and have mud on my clothes and calls on my cellphone I didn’t remember making.”
She went to her first 12-step program in September 2006, and has been sober and attending meetings ever since.
For Andrew Kahn, post-surgical depression played a role in his turning to alcohol. Within a year of his 2003 surgery, he went from 367 pounds to 180 on his 5-foot-7-inch frame. He joined a gym, and in 2005 ran a marathon.
But the excess skin that sagged from his belly like an apron depressed him. Like many patients who lose a lot of weight, Kahn’s skin didn’t shrink with the rest of him. “It just hangs there. I hate looking at it,” he said.
Though his insurance covered his weight-loss surgery, in 2008 the company declined to pay for the skin-reduction surgery, which is considered cosmetic. And Kahn couldn’t afford the $10,000.
That’s when he started drinking. “My finances were bad, I couldn’t do anything about the extra skin, which depressed me, and vodka would tell me everything was OK.”
Though he wasn’t much of a drinker before his surgery, and he hadn’t had any alcohol for five years since the procedure, that changed.
“If I had one to two drinks, I could get very stoned very quickly.” Soon one to two drinks became five to seven miniature bottles of vodka. He started drinking in the morning, and often woke up shaking. “Drinking made me boisterous and destructive,” he said. “My wife was furious with me.”
Last August, he checked himself into a detox clinic.
Weighing the risks
Still, experts agree, the benefits of the gastric procedure — eliminating diabetes, reducing high blood pressure and heart disease and curing sleep apnea — greatly outweigh the risks.
“The increased risk for alcoholism after gastric bypass should be balanced against the many positive health effects of the surgery and weight loss,” said Ostlund. “Surgeons have to advise patients to consume alcohol with care.”
Before he operates, Dr. Raul Rosenthal, a bariatric surgeon in Fort Lauderdale, says he puts patients through a psychological exam to be sure they can withstand the adjustment.
“We look at their alcohol and tobacco use, and other addictive behaviors,” he said. “It’s important for patients considering the procedure to be told that the risk exists, and that if they had a tendency to drink before, they will need to be very careful.”
From a Medical Malpractice perspective a doctor needs to first determine whether a patient is a candidate for bariatric surgery.
Bariatric surgery should be considered in persons with a body mass index (BMI) above 40–about 100 pounds of excess weight for men and 80 pounds for women. Persons with a BMI between 35 and 40 who suffer from type 2 diabetes or life-threatening cardiopulmonary problems such as severe sleep apnea or obesity-related heart disease may also be candidates for surgery. In addition, a person with obesity-related physical problems that interfere with employment, walking, or family function may be a candidate.
Body mass index is determined by dividing a person’s weight in kilograms by height in meters squared. To determine BMI using pounds and inches, multiply the patient’s weight in pounds by 704.5, then divide the result by the patient’s height in inches, and divide that result by the patient’s height in inches a second time.
An NIH consensus conference on the surgical treatment of obesity recommended consideration of surgery in patients with a BMI of greater than 40 kg/m2 without medical complications or a BMI of greater than 35 kg/m2 if a severe comorbidity were present. Other factors to consider are:
- MI > 35 kg/m2 and significant obesity comorbidity (e.g., hypertension, diabetes, sleep apnea, pickwickian syndrome, incapacitating osteoarthritis)
- Documented failure to keep weight off or to prevent further weight gain using aggressive medical management that has included behavioral, pharmacologic, and low-calorie-diet components
- Psychological ability to comprehend the expected changes in dietary intake necessary following surgery to achieve and sustain weight loss
- Willingness to maintain continued medical management following surgery, including visits to registered dietitians, internists
- Adult, nonpregnant, absence of drug addiction or chronic disease unrelated to obesity
After determining whether the individual patient is a candidate for surgery from a physical standpoint, a doctor needs to evaluate a patient from a psychological standpoint to measure that patients addictive personality; the failure to do so may be medical malpractice.
Finally, the doctor must provide the patient with an informed consent, so that the patient can understand and acknowledge all the risks associated with the procedure. Again, the failure to so, may be medical malpractice.