[NP-Clinical] Re: fosamax

Sat Mar 10 06:06:47 PST 2007

The surgeons typically discharge someone from care one year post-op if there
are no complications. They should have their labs monitored once a year by
their PCP and continue attending post-op support groups through their
obesity surgery program. Ideally one should find a program (usually
associated with a hospital) that has an intense and lengthy pre-op program
where they learn about nutrition, lifestyle changes, exercise, pre and post
op diet and care, and that will provide continuous life-long post-op
support. All too frequently though, patients don't go through an obesity
surgery program and just find a MD that will do the surgery and then they
lose out on all the valuable information a patient needs for long-term
success. 

Reasons a patient my not complete the one year follow-up with their surgeon:
the surgeon may not be part of a obesity program and therefore not do one
year follow-ups once the patient is stable post-operatively, the patient's
insurance might have changed an the MD is not on the new panel, the patient
lost his insurance and can't afford to go see the surgeon, the one year
post-op period has ended and there is no need to see the surgeon, the
patient may not have understood that they were to follow-up even if they
felt great and everything was going well, the patient might have moved and
is no longer close to the surgeon, the surgeon moved or retired and is no
longer close to the patient. As with any other surgery, there reaches a
point where surgical follow-up is no longer necessary (I would think
lap-band patients would need to continue to be followed as long as that band
is in place) and a PCP can assume care if there are no problems. My PCP
monitors my weight, asks about my diet, refills my chewable prenatal
vitamins and Prevacid, and orders my lab work (CBC, CMP, lipids, Fe, B12,
Folate, TSH) every year. She also ordered my bone density test and started
me on Actonel as well as referring me to GI for an endoscopy to r/o ulcers
when I had symptoms trying to DC the Prevacid. There's nothing else that
needs to be done.  The biggest problem for gastric by-pass patients post-op
is effects of malabsorption (including osteoporosis) and that's what needs
to be monitored... along with the weight.
Dena Galler

-----Original Message-----
From: np-clinical-bounces at nurse.net [mailto:np-clinical-bounces at nurse.net]
On Behalf Of Sue Wiers
Sent: Saturday, March 10, 2007 4:02 AM
To: np-clinical at nurse.net
Subject: RE: [NP-Clinical] Re: fosamax

Thank you for the of the input.  This is my third s/p bypass patient that I 
have inherited and had failed to follow-up with their surgeon for whatever 
reason.  It is scarey to me that these folks are having such a major 
procedure done and have no long-term monitoring by someone who has a clue 
(which i don't).

Sue

>From: Julie Orfirer <jeorf at yahoo.com>
>Reply-To: NP Clinical <np-clinical at nurse.net>
>To: np-clinical at nurse.net
>Subject: [NP-Clinical] Re: fosamax
>Date: Fri, 9 Mar 2007 05:22:22 -0800 (PST)
>
>Sue,
>
>First you want to be sure that this is someone you want to treat with 
>drugs.  What is her fracture risk profile?  (Does she have any of the big 
>4? Personal or first degree family member history of low-trauma fracture, 
>current smoker, weight under 127#)  What are her T-scores?  How old is she?

>Hopefully very very soon we'll have the WHO-2 that will give us those new 
>guidelines (tapping fingers impatiently on her desk for the past 1-1/2 
>years...) that may help.  Is she getting enough calcium and vitamin D?  
>That's a real toughy for these folks - I think it's a good place for 
>chewable calciums (a bit easier on them than the giant pills) - there's 
>even a gum now that you chew for 5 minutes (and don't want to chew any 
>longer than that 'cause it tastes nasty after 5 minutes).  Do test her 25 
>(OH) vit D and make sure it's over 32.  (I doubt that it is unless she's 
>supplementing well - most of our bariatric surg patients have horrendous 
>vit Ds.)
>
>If you do decide that you want to treat her with a bisphosphonate you might

>consider the liquid Fosamax.  It's still a big bolus of liquid because it 
>still needs to be taken with water but we find it more tolerable for some 
>folks.  If she has problems with it tho the injectable Boniva is probably 
>the best bet.
>
>Julie
>
>
>Message: 1
>Date: Thu, 08 Mar 2007 11:44:52 +0000
>From: "Sue Wiers"
>Subject: [NP-Clinical] fosamax
>To: np-clinical at nurse.net
>Message-ID:
>Content-Type: text/plain; format=flowed
>
>I have a woman in her mid-fifites who had gastric bypass 4 or 5 years ago.
>Subsequently, her surgeon has left the area and no one took over his
>practice.  The patient had been on ERT (s/p hyst) in the past and was taken
>off for reasons that I cannot recall at the moment.  The last two annual
>bone densities have each demonstrated significant interval loss in density
>although still not outright osteoporosis.  Does anyone out there know if a
>person following gastric bypass can take Fosomax?  I am not sure if the
>potential esophageal effects may be more pronounced or not.
>
>Sue Wiers FNP
>
>
>
>
>
>"To affect the quality of the day, that is the highest of the arts." - 
>Henry David Thoreau
>http://sculpturefest.org/pages/artists2006/markey.html
>
>---------------------------------
>Be a PS3 game guru.
>Get your game face on with the latest PS3 news and previews at Yahoo! 
>Games.

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