Does Bariatric Surgery Turn You into a Sex Maniac?

I was surprised when I walked into the exam room to see my next patient. Her chart identified her as a new patient, although her name was vaguely familiar. I realized why when I saw Susan (not her real name) waiting for me on the exam table. She was a pharmaceutical salesperson (we call them “Drug Reps”) who had only recently started calling on me. About two weeks ago her company had hired me as a speaker to promote one of their (non weight loss) drugs that I prescribe in my general practice. The meeting was held in a private dining room of a trendy restaurant. Very few physicians showed up and there was a lot of time to kill with me chatting with the reps from this company. Naturally a lot of the conversation centered around weight loss, since that is my specialty .

Susan met me for the first time at that meeting. She was about thirty years-old, very articulate and intelligent. She had an attractive face and she appeared to be just a smidge over ideal weight. I remember thinking that her interest in weight loss seemed out of proportion to her own situation, but that is not common, especially with women.

She was very tense and tearful, totally at odds with the very professional and relaxed appearing woman that I had chatted with recently. “Can you take Wellbutrin and Phentermine together?” she blurted out, choking back tears. “Does Wellbutrin cause you to act crazy?”

I should explain here that Wellbutrin is anti-depressant, the only anti-depressant that doesn’t cause weight gain (and may cause a small weight loss). Phentremine is an appetite suppressant that I commonly prescribe.

This was an unusual way to start a physician/patient relationship, to say the least. I asked her to back up and explain why she wanted to know, and also why she was so upset.

Her story was hair-raising. It seems that immediately after my meeting with her, her husband and her own parents had had her committed for a few days to a psychiatric hospital. She had just gotten out before our visit.

After the birth of her daughter, now aged eight, her husband had stopped having sexual relations with her. She ate out of depression and her rate ballooned to almost 300 pounds. Unable to lose the weight, she had bariatric surgery and went down to 150.

Then it got interesting. She began to participate in Internet groups looking for sexual partners. After a few months she let herself be filmed having sex with three men simultaneously. As what happens every time something like this occurs someone who knew her and her family saw these pictures and alerted her family.

She had been placed on Wellbutrin a few months prior to the surgery for depression and her family was trying to blame this drug for her behavior. She had regained 15 pounds during her week in the Psych hospital, wanted to take Phentermine and continue her Wellbutrin (thus her opening question to me).

Her story interested me even more than it normally would because of a few other patients that I have seen recently. Another one had had bariatric surgery in Ohio, had moved to Chicago and wanted me to follow her. She had asked for an HIV test and in the course of counseling her, she let slip that since she had lost weight in surgery she was participating in orgies (her husband also participated--at least this time it was a family activity).

Another patient was seeing me because her husband had had bariatric surgery and was losing weight rapidly and she wanted to lose some weight non surgically. On her third visit she was crying because two nights before she had caught him on the Internet entering his info into E-harmony. She proceeded to divorce him.

The psychiatric literature is replete with articles about patients who after bariatric surgery become addicted to alcohol, cocaine and other drugs, or compulsive gamblers. The speculation by the various authors is that some obese people tend to engage in compulsive behaviors (such as overeating). When they can no longer overeat because of the surgery, they find other outlets for their compulsions.

I have to say that after many years of helping people lose weight non-surgically I haven’t seen that kind of problem in my patients. Perhaps because these people have to work at it, and as part of that they wind up examining what makes themselves tick, and they learn how to deal with their compulsions rationally. The patients who go for surgery tend not to be to introspective: they want the quick fix and they don’t really want to examine their lives and make changes. I’m not going to pretend that I have all the answers. However, I do think examining the question is very interesting...

New Blog to Start...

We're starting a new blog that'll be like a sister-blog to this one. It'll be written by me (sorry folks) about my experiences of going through the weight loss program. It's guarenteed to be somewhat snarky at the least, so if you like that sort of thing check it out. It's on the list of blogs on the side of this very page. ^_^

If you don't know who "me" is, I'm Jill, the receptionist at the Hoffman Estates office. I work in the Elmwood Park office Monday mornings as well, though any of the patients who remember me are scary-good at remembering tiny details and may want to look into becoming detectives for a living. Or something. I'm also Dr. Finegold's daughter, so when he asks (nicely) that I do something I really have no reason to say "no". So...here we are. I'll go update the other blog now.

Are You a Real Doctor Too?

I love it when I hear patients say: “I didn’t keep my appointment with you last week doctor because I was sick.” Or when they describe their other medical problems and I start making comments, if they say “Are you a real doctor, just like my doctor?”

I guess I can’t blame patients for their confusion. Most physicians who deal with weight loss--and there aren’t that many of them--do nothing else. Dr. Elhag and I are somewhat unique in that we have kind of a dual practice. We are primary care physicians who have done extra training in weight loss medicine. We still practice primary care internal medicine.

I know that we are all specialized these days, and perhaps patients like the idea of seeing a doctor who does nothing but weight loss medicine all of the time. However, from my standpoint, I think that primary care physicians are the best physicians capable of dealing with weight loss issues.

First of all, we see all the complications that come from obesity. I first became interested in this because for many years I’ve been treating people for diabetes, coronary artery disease, sleep apnea, hypertension, breast, prostate, and uterine cancers, back pain, knee and hip arthritis, infertility, and many of weight related illnesses. You get tired of treating each problem independently with a plethora of medications. Eventually you’d like to treat the root cause of all these problems and make them go away.

We also get to see the side effects of many medications prescribed by other physicians. I don’t know how many psychiatrists that I’ve had to inform that our mutual patient has gained fifty pounds because of the medications that that doctor has used, only to have the shrink deny that their medication was the culprit. Now there is an increased awareness of this in the psychiatric community but it took years. The same can be said for estrogen replacement therapy, many blood pressure medications, seizure medications, and a host of others. As PCPs we are aware of what medications can cause these problems, what may perhaps be a better alternative, and how to coordinate these issues.

Another issue is how to deal with the favorable effects of weight loss. For example, diabetics on insulin make dramatic improvements in their blood sugar with small amounts of weight loss. Since as PCPs we prescribe diabetic medications constantly, it is easy for us to advise the patient what to do as they lose weight. The same can be said for the cholesterol and blood pressure medications.

Many times I’ve had a patient in for their routine weight loss checkup with a bad cold, or asthma attack, or some other acute problem. It is both gratifying and amusing to have them realize that we aren’t just “weight loss doctors” when we treat that other problem as well.
Our weight impacts our entire health. I think that primary care physicians are in the best position to deal with that whole person.

Shakes, Bars, and Less Expensive Groceries. Oh My!

Jill was telling me a story the other day. It was about a patient of ours who had started the weight loss program as a less-than-enthusiastic participant. She had tried Weight Watchers, Jenny Craig, and every fad diet under the sun and ended up gaining weight in some instances. She'd just about had it with even trying to lose weight.

She'd come in for a free consult two months ago and asked a lot of questions with little hope in her voice. After conducting an IC on her we saw that her metabolism was actually normal which did little to make her happy. When I had Jill show her the supplements she had heaved a weary sigh and glumly bought three items (two sets of protein bars and one set of strawberry shakes; this should last any patient for two weeks).

When I was with another patient about a month later this lady stepped in to be weighed. We let our patients use our scale all the time at no cost as long as someone is here to input the data. It sends an elecetric current through the human body through the feet at a current so low you can't even feel it. The current bounces off of fat and muscle which have different densities and tell the doctor and patient how much of either substance is contributing to the number the scale reads for their weight. With diet and exercise a patient might not lose weight because what was once fat is now muscle (which weighs more), but the muscle burns fat and is in fact much healthier.

Anyway, the patient had stepped in to hop on the scale to see what, if anything, had happened. It turns out she had lost almost ten pounds in about three weeks, a healthy weight loss, and was feeling more energentic than she had in years. She quickly bought ten supplement and meal replacement items with a big smile on her face.

While on I'm on vacation, Jill is still in the office selling supplements. The patient stopped back in to be weighed (this is now almost two months after her initial visit) and lost nearly ten more pounds. Jill said she was having trouble understanding her because she was so excited that she was talking in a constant stream. The patient bought nearly twenty items, and when Jill questioned it she said this:

"I've lost so much weight and am so happy just by having a bar or two a day and walking around more that even my husband started sneaking my bars. I just figured I'd buy more. We've stopped buying as much stuff at the grocerey store because we're not as hungry with these bars around now!"

Jill says that the patient says she currently saves almost three hundred dollars on groceries now. I was floored, and can't wait to congratulate her on her next appointment. All this without the appetite suppresent too!