Estoy tomando mis vitaminas.

“Take your vitamins!” “Drink your milk!” What household across the United States are these common phrases not spoken? Probably quite few, we are a first world country after all. They came as Flintstones in our house. Mom saw that we got our square meals, and we never went hungry. Were supplements really necessary? Probably not, food pyramid bases were more than covered, but once a day we ate our vitamin nonetheless, whether Dino, pebbles or Wilma.  And now here we all are, all grown up big and strong. Healthy.

Places like West Africa, Thailand, Nepal, refugee camps and local areas where food staples consist of rice, rice and more rice there is a very different story, than the one I can share. There are no square meals, there is always hunger, and here, where supplements would be most needed, there are none. Malnutrition, a common cause of disease, plagues the population. These rice subsisting communities are frequently vitamin deficient. One such vitamin is B1, or Thiamine. Clinical signs and symptoms of Thiamine deficiency originate from the Cardiovascular system, GI system, and perhaps the most severe forms affect the nervous system. Ultimately, if left untreated, it can result in death. 

So why am I talking about vitamins? Who would be vitamin deficient in the US? Well, alcoholics for one, but I don’t want to talk about that now. I am currently on the Minimally Invasive Service. It’s an efficient service, with excellent Attendings. I enjoy learning from each of them, and hope my laparoscopic skills can one day be enough to rival theirs. Our service is heavily a Bariatric Surgery service. This is another subset of the population in which you will frequently see vitamin deficiencies, Thiamine included. In fact, it’s a serious enough possibility, that every post op patient we see needs to have their levels checked. The patient could be in the ED having stubbed his/her toe, and yet my attending is going to want to know the vitamin levels before paying the poor toe any mind. 

I can not rectify in my mind the vast difference between the above two etiologies of Thiamine deficiency. We live in a world where there is so so much we electively choose to alter our bodies in order to create a situation that reflects a world of so so little. 

We recently had on our service a patient that came to us from another country where she had undergone Bariatric surgery. The surgery had been complicated, and thinking that she could potentially die, she had flown home and came directly to our hospital. If she was to die, she had wanted to die in the US. The saddest part of this story, is that the patient was not obese, based on her BMI, she wasn’t even over-weight. She had just wanted to be a few pounds lighter. The surgeon should have told her she was beautiful, advised to stay away from the midnight ice cream snacks, and sent her on her way. 

I have heard the success stories after Bariatric surgery. I’ve seen them as well, and rejoice with the patients essentially cured of their diabetes and aching knees, etc. But despite that, I can not and will not ever recommend Bariatric surgery to anyone. 

Much Love.