Internal medicine, first of all, allows us to overcome chronic disorders, which rarely disappear. For every pneumococcal pneumonia we eradicate, we have many HIV patients who will be treated indefinitely. Diabetes, once a deadly disease, is now a chronic disease for most patients, and even with treatment, the path is usually progressive.
One of the most satisfying exceptions to my professional life has been the introduction of stomach surgeries that reduce the incidence of disease and seem to prolong the course of those who successfully undergo those procedures. Roux-en-Y gastric bypass և gastrectomy has kept thousands of patients in better health for many years, giving them a second chance. However, for the subgroup, this second possibility comes with the temptation to use substances, especially alcohol, that go beyond their preoperative use.
Increased alcohol consumption after surgery
The Department of Veterans Affairs (VA) team recently revised their large central database to determine changes in alcohol consumption among patients undergoing bariatric surgery. The VA regularly conducts the Alcohol Abuse Identification Test (AUDIT-C), a study that has been validated as a reliable assessment of individual alcohol consumption. It is embedded in the VA Health Electronic Record where it can be easily downloaded. Comparing the results of this study with those who underwent bariatric surgery and survived at least 8 years after surgery, the authors were able to trace alcohol consumption trends 2 years before surgery and 8 years after surgery.
Using the same database, the authors identified slightly less obese patients under non-surgical control, but otherwise matched a number of comorbid elements, such as hypertension, certain psychiatric disorders, and personal habits, including alcohol use.
Alcohol use is classified as nonexistent, minor social use և “unhealthy” use. Of those with no primary or minor social use, 4% became unhealthy at age 3 and about 5% at age 8, significantly more than in the non-surgical control group. Those who underwent gastric bypass surgery underwent slightly more conversions than those who underwent gastrectomy or not.
Patients with alcohol underwent an interesting course after the operation. Consumption decreased from the second year of surgery to the year of surgery, suggesting that limiting its use may have been a surgical precondition. After the operation, they returned to an unhealthy level of drinking. Those who underwent T-gastrectomy consumed the same amount of alcohol as their respective non-surgical controls, but those who bypassed increased their initial unhealthy use of controls.
Because frequent abstinence is often recommended for the treatment of alcoholism, the research team assessed the extent to which abstainers abstained. In anticipation of surgery, abstinence rates increased until the year of surgery, but three years after surgery, consumption often reached unhealthy levels, with no more than participants with pre-existing drinking problems.
Sm խ ումը Illegal drug use
Although alcohol abuse has been the subject of much research, some attention has been paid to smoking մանը illicit drug use, which may also increase over time.
A small study looked at tobacco, alcohol և drug use 2 years ago և postoperatively using population data. The authors found a parallel example where users voluntarily reduced their use of the material before surgery, but repeated it as the procedure made them more functional, perhaps more independent. Alcohol from human resuscitated substances significantly included the largest increase in preoperative use.
These studies reveal as much as they can what? happened more effectively than they reveal why? it happened The latter requires some clinical experience. Prenatal use of Cigarettes and alcohol was possible to the satisfaction of the surgeon. It is possible that many patients saw this as their second chance to save.
The stimulus to undergo surgical weight loss, which carries a certain risk of forcing long-term eating habits, includes avoiding future illnesses and promoting longevity. Thus, postoperative behavior that threatens the long-term goal should become a component of ongoing post-traumatic stress disorder.
Acquiring unfavorable behaviors that do not occur in the preoperative phase is more difficult to classify, յուրաքանչյուր obliges each of us to ask about changes in alcohol use և provide them with resources if they need intervention.
Richard M. Plocker is a retired endocrinologist with over 40 years of experience treating patients in both private and hospital settings. He has been an investor in Medscape since 2012.