LouiseF

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Dear Fellow migraine sufferer

You are here because you need some amunition to use in your request for Vertical Sleeve Gastrectomy vs RNY. As you know the Ontario Bariatric Surgeons prefer to do the RNY. If you have RNY you can't take NSAIDS- Ibuprofen, Advil, Naproxen etc. All medications that are essential to treat migraine. I am sharing what I said to my surgeon to convince him that the only surgery that I could have and still enjoy a productive life was one that allowed me to continue to take NSAIDS- VSG. Each of you will have different history and be at different stages of life. I am post-menopause- many doctors will tell you that migraines go away with menopause,  that has not been true for me. Please feel free to use the links and key points I have posted here. Do re-write it to suit your particular situation.

I have suffered from migraine headaches since the age 9. Unfortunately, I continue to have migraine headaches at least three times a month, post-menopause. I have made significant life-style changes to reduce the incidence of migraine; however, these do not completely eliminate migraine attacks. Ibupofen gel caps are my best friend, helping me to treat migraines and allowing me to live and work most days. I still lose days, but not as many as before I started to use Ibuprofen.

The expensive Triptan medications work sometimes, but can't be taken too frequently. Also, right now I have a drug plan, without one I couldn’t afford Triptans.

Here are some talking points that I used when I met with the surgeon. It is not worth discussing RNY vs VSG with anyone but the surgeon, only they can make the decision. The other staff are being told to push RNY only. It will just give you more anxiety and stress and make NO difference if you discuss it with the nurse, social worker or dietician.

• I have been informed that NSAIDS are contraindicated when Roux-en-Y gastric bypass surgery is performed. I appreciate that the RNY surgery has both restrictive and malabsorptive properties and, for most, is a better choice for long-term success.
• Due to the severe disability I suffer with migraines, I cannot undergo a procedure that prevents the use of NSAIDS. Thus Vertical Sleeve Gastrectomy is my only option for bariatric surgery.
• My family doctor and Neurologist, have managed my migraine care over the years. During that time, numerous preventative medications have been tried: beta blockers (Propranolol); anti-convulsants (Gabapentin and Topiramate); and anti-depressants (Amitriptyline). None of them has been effective.
• My current migraine medication regimen is based on recommendations from clinical practice guidelines, supported by good quality evidence from clinical trials. The most recent recommendation from the European Headache Foundation in September 2009,  states: " For the acute treatment of migraine attacks, oral non-steroidal anti-inflammatory drug (NSAID) and triptans are recommended."   S. Eversa, J. Afrab, A. Fresea,c, P. J. Goadsbyd,e, M. Lindef, A. Mayg and P. S. Sandorh, EFNS guideline on the drug treatment of migraine – revised report of an EFNS task force, European Journal of Neurology 2009, 16: 968–981.

 

• I take Ibuprofen gel caps and Maxalt, a triptan to treat my migraines. The latter is a specific anti-migraine medication. This is supported by good clinical evidence.          

• There are two reasons for having more than one medication: (1) sometimes one doesn't work; and (2) triptans cannot be taken more than twice a week, NSAID's no more than three times a week. It is not uncommon for me to have migraines more than twice a week and sometimes the triptan effect does not continue over the full course of the migraine and I have to take a combination of medications for effective relief.
• Use of narcotic analgesics, such as Tylenol 3, or Oxycodone, are not recommended and usually cause rebound headaches when I use them for emergency 'rescue'. That is when a migraine is resistant to the other medications. Due the extreme disability I experience during a severe migraine, going to a hospital emergency department for migraine relief, is not an option.

 

 

Some links to current clinical practice guidelines for migraine management.

 

Evidence-Based Guidelines for Migraine Headache in the Primary Care Setting: Pharmacological Management of Acute Attacks.

http://www.aan.com/professionals/practice/pdfs/g10087.pdf

 

Practice parameter: Evidence-based guidelines for migraine headache. http://www.neurology.org/cgi/content/full/55/6/754?ijkey=bcc2087f4d1677c3874a6f6649ccf2bd5d850658&keytype2=tf_ipsecsha

 

 

Acute migraine therapy: recent evidence from randomized comparative trials.

http://www.ncbi.nlm.nih.gov/pubmed/18451718

 

EFNS guideline on the drug treatment of migraine –revised report of an EFNS task force.

http://www.efns.org/Guideline-Archive.389.0.html?&docID=1199&eID=dam_frontend_push

 

 

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After writing my last post about goal weight and the site about ideal weight, I had a short period of doubt about WLS. Should I do it? Then I looked back on my diet history and how I lost 50 lbs and then put that plus another 20 on after the diet ended despite eating a moderately good diet. Stress was a factor in the gain, as well as a job that had me eating at weird times and no time for cooking like I do now. The wait for surgery is good in a way as it has helped me to think thru all the ramifications if I do it and if I don't.
To add to my reasons are my co-morbidities: High BP, GERD, most probably sleep apnea, and osteoarthritis of my right knee.

My right knee is f*cked due to me being fat. Just my right knee. Yes, it's messed up because the doctors who saw me - emerg and two out of three orthopedic surgeons, only saw a fat, forty plus year old woman. They did not listen to my history or how the knee was injured. If they had, my torn meniscus/cartilage would have been repaired in a few weeks. Instead it took three years. Three years of pain, episodes of locked knee and disability. I couldn't work. So now my knee has damage caused by the ignorance and fat bigotry that exists in supposedly intelligent people.

I followed a link that someone posted on OH.
http://www.healthcentral.com/diet-exercise/ideal-body-weight-3146-143.html


Ideal weight range is 158 - 173.8 lbs. (71.8 - 79 kg.).
You are overweight by 53.2 lbs. (24 kg.).
You may wish to consult with your physician for medical help

This is what came up for me. My memory of when I was thin? What does that mean? Well anyways, I recall 140 lbs, so that is what I put down for a goal. When I saw the internal med MD, he said I would probably lose only 60 lbs. So he thought my weight should be lower- but that I could only lose that much.

I am about to take a journey. For some time I have been reading and researching, taking stock of my inner resources, outer supports; finances, friends and family. If all goes well, I won't need too much support, but if I don't take this chance I will need far more support as time goes on. I hope to undergo bariatric (weight-loss) surgery in the next few months.

 

There is a lot of bad science and just down right lies out there about diets and weight loss. Dieting is a multi-billion dollar industry, that only cares about money. In later posts I will share some links and excerpts of good evidence, of why dieting does not work for the vast majority of people. For now, I will share one paper. Aptly titled, Dietary Therapy for Obesity: An Emperor With No Clothes: Dietary Therapy for Obesity: An Emperor With No Clothes,  it was published in the journal Hypertension, the Journal of the American Heart Association. 

 

http://hyper.ahajournals.org/cgi/content/full/51/6/1426

 

The facts. I am 55, obese with high blood pressure, a hiatus hernia and as a result, GERD (gastro-oesophagus reflux disease). I have gouty arthritis in my right ankle, my left knee has osteoarthritis and I have degenerative disc disease in my upper back.. At 5' 7", my BMI is 35, with the above co-morbidities I am eligible for bariatric surgery.  Now I know that BMI is not the best measurement, but that is what is used in health care at this time. I am not a mass of muscle. I can walk for several miles without collapsing, I live a sedentary lifestyle but do garden, haul firewood and  other odds and sods. I don't like to exercise for the sake of it, I like to walk if I am going somewhere. I might get a treadmill.

 

Both my father and mother had cardiovascular disease, both suffered strokes and had heart failure. My mother had type two diabetes that required insulin. My father lost the sight in one eye due to his diabetes (his was a rare form not due to obesity). Both were obese. My aunt lies in a nursing home, more than ten years after suffering a stroke: she is unable to care for herself, feed herself, she cannot communicate.

 

In my work as a Registered Nurse, I see the results of poor health, these are not all related to obesity, but obesity is a significant component of the misery and pain I see on a regular basis.

 

My battles with GERD started in the late 80's. At the time I was under stress, but happy. I had gained perhaps 20 lbs, living in student accommodation, working and undergoing post-graduate health care education in the UK. With treatment it resolved.

 

Since 2004, I have had intermittent heartburn, which I managed with over-the-counter remedies and changes in diet. In 2007, I developed pneumonia and on x-ray, my right middle lobe had collapsed. After several weeks of tests, a specialist told me that this might be due to aspiration caused by the GERD. It took over six months for me to recover. There were significant economic costs attached due to sick time and inability to work full time for several months.

 

In 2008, the GERD became worse. Prescription medicine was needed. My interest in surgery, to repair my hiatus hernia, began after I had seen three different people with swallowing difficulties in 2008. Two had GERD in their past. A little research on the internet told me I was at risk for more serious health problems, including cancer of the oesophagus.

 

At the end of 2008, I took a belly-dance class to try and improve my fitness level. It was only when I was standing in front of the mirror that ran the full length of the room, that I realised how fat I was. I knew I was not skinny, but my mental image of myself and what I saw with my eyes were different.

 

Over the years I have dieted.  At one point I lost over 50 lbs and wore size 10 jeans. In 2004, after several years of extreme stress, (death of my parents, family home burnt down, illness, job loss, serious family health issues- nephew had leukaemia, sister housebound with Panic Disorder and other stuff) I was wearing a size 20, my weight had gone up to 240 pounds.

 

Rather than diet, I started to eat more mindfully. Strangely enough, stopping the use of sugar substitute helped. My weight has stayed about 225 pounds for most of that time. I did drop to 210 with the pneumonia- mostly because I coughed so much, I vomited almost daily.

 

I have the most wonderful family doctor. When I asked him to refer me to a doctor to see what could be done surgically to correct my hiatus hernia, he was more than happy to do so. I oh so casually mentioned a surgeon's name, who by the way, was known for his practice in benign oesophageal disease, what I didn't tell him, but he probably knew, this doctor also performed bariatric-weightloss surgery.  Despite my good relationship with him, I was embarrassed to tell him that I wanted bar iatric surgery. Despite all my knowledge of why diets don't work, I felt ashamed that I had failed to lose weight and maintain the weight loss.

I am going to stop being ashamed and instead go forward knowing that I suffer from a disease called obesity. The causes are most likely genetic, but a toxic environment has aggravated it.