FORT GORDON, Ga. -- With a family history of diabetes and weight issues, Abbie Maracin realized that she couldn't lose weight on her own, so began the process to undergo gastric sleeve surgery over a year ago.
Bariatric surgery to aid in weight loss is one of the most fastest growing elective surgeries performed in the U.S. and has proven to be an effective way to increase long term weight loss.
"I tried everything, this was a last resort for me, this was a realization that I am so far beyond what I can handle myself," said Maracin.
When she began to investigate bariatric surgery, the surgeon at Eisenhower Army Medical Center (EAMC) explained the preparations and what would be expected of her with diet and she was introduced to Dr. Christopher Bland, EAMC Critical Care Pharmacist, who would be her bariatric pharmacist.
In 2010, surgeons who did bariatric or gastric bypass surgeries started to see patients going to their primary doctor or the emergency department for issues not related to the surgery, but due to their medications. At the time, there weren't pharmacists who specialized in bariatric pharmacy and Bland wanted to find a way to help.
Bland explains that he "was asked to get involved and one of the reasons people want bariatric surgery is to come off their medications. What we didn't realize is that it happens very quickly and so for a lot of those patients that were on high blood pressure or diabetes medications, the benefits of surgery happen pretty much immediately, so you need a proactive plan to address that."
Patients would come in with low blood sugar and low blood pressure and would need Bland to readdress the doses of their medications.
"I was brought in to help facilitate them having their surgery and then a follow up with me to prevent an adverse effect from the drugs."
Since Maracin's surgery she has lost 125 pounds and come off of some of her medications following her gastric sleeve procedure six months ago.
"I have five children and I had to make the decision to change my life for me and my family. I was extremely morbidly obese so it was a death sentence. One of my children has special needs and how would I help her if I am not talking care of myself," said Maracin.
Bland describes that the primary adverse effect on patients was low blood sugar, or hypoglycemia, and low blood pressure in patients following the bariatric procedures. Most of the changes come from a modified diet which almost immediately affects the patient's levels.
For the first week after surgery patients only drink clear liquids and consume less salt so the risk of low blood sugar and low blood pressure goes up exponentially.
Additionally, there are hormonal changes that happen after the surgery that are still not completely understood along with notable decreases in insulin resistance in patients.
This can cause people to come to the emergency department with fatigue or because the feel terrible. This can affect the recovery after surgery and if the patient has a significant cardiovascular history, it could trigger an event like a heart attack.
"I started with more of a common sense approach in looking at what would get a particular patient in trouble the fastest, what would do the greatest harm to them if I didn't adjust that medication," stated Bland.
Over time Bland has honed the process where it now includes a screening appointment with every patient before their surgery where he develops a plan to address their medication before the procedure.
"Now, I see everyone before their surgery to look for problems, I interview the patient, look at their medications, and try to see what prescription meds they are on, what over the counter or herbal supplements they are on, and address anti-inflammatory drugs, because those like Motrin or Aleve can really increase the risk of an ulcer after surgery."
"When the surgeons told me that patients were at a safety risk it was one of those things you have to do, you have to find a way to help. Currently bariatric pharmacy is an add-on to my job but it's a necessary add-on. If a lot of hospitals examined this, they would see that this is an unmet need at their facility as well," said Bland.
Bland sees the bariatric pharmacist, someone who specializes in the obese population, weight loss medications, and drug dosing in obese patients as a new field of pharmacy.
"There are several signs that show that bariatric pharmacy will be the wave of the future and that is where I am hoping this will lead, with more research and specialization."
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