Recently, I received a “special” gift – a poem written by the patient himself, Brother Li. This is the voice and emotion of Brother Li, who has been holding back his body for more than 10 years. As a medical practitioner, I feel relieved and would like to share with you the story of Brother Li, hoping to bring you some inspiration. I remember a month ago, Brother Li came to my office with a heavy body and an emaciated face. As soon as he was seated, Brother Li began to tell me about his painful experience of struggling in the dead end of constantly regaining weight for more than a decade: Brother Li from Heilongjiang, 45 years old, is a state civil servant, more than a decade ago he used to weigh 156 pounds, with the growth of years, the meal was twice the normal size of Brother Li began to gradually gain weight, plus the accumulation of various late-night snacks and carbonated drinks, weight slowly increased to 220 pounds. In 2004, Brother Li began to lose weight through dieting, reducing to 170 pounds within a year. But the good times did not last long, in 2007, its weight will gradually rebound. And the last four years, a variety of social and life irregularities, so that the weight of Brother Li quickly soared, the heaviest when it reached 240 pounds. More frightening is that, because of “fat”, brother Li appeared sleep apnea syndrome, this disease makes him sleep at night during an average of once an hour to hold awake, brother Li every night in worry about their own in their sleep silently away. Why do sleep apnea occur at night in obese people? Obesity and sleep apnea syndrome The direct pathogenesis of sleep apnea is the narrowing and obstruction of the upper airway, which is actually airway collapse, and is accompanied by impaired neuroregulatory factors in the respiratory center. Obesity is one of the most important factors causing sleep apnea. Because obese people accumulate a lot of fat in the neck and pharynx, making the pharyngeal cavity narrow; at the same time, the pharyngeal muscle is relaxed during sleep, and these relaxed fatty tissues are more likely to collapse the soft oropharyngeal wall between the soft palate and the epiglottis under the effect of negative pressure during inspiration, making the airway obstructed, thus leading to apnea. Therefore, many obese people often wake up in their sleep. In case they don’t wake up once they hold it in, they can easily leave quietly in their sleep …… And during apnea, the decrease in oxygen saturation can lead to a series of arrhythmias, including sinus bradycardia, sinus arrest, atrioventricular block, and ventricular arrhythmias, increasing the risk of angina pectoris and cardiac infarction at night. In addition, the hypoxemia and hypercarbia caused by repeated apnea increase the patient’s sympathetic tone, making the patient more likely to develop pulmonary hypertension and hypertension, which can lead to ventricular hypertrophy and cardiac dysfunction in severe cases. As expected, Mr. Li’s blood pressure already belonged to the high-risk group of hypertension, and was accompanied by hypertensive heart disease and other diseases, and of course did not “escape” the most common diabetes in obese patients, fasting blood sugar reached 8.3 mmol/L. And because of the weight squeeze, 5 years ago, Mr. Gao’s knee joints became sore and uncomfortable, legs were dry and rough, and accompanied by depressed edema, the entire lower extremities showed The entire lower extremities were gray-brown. In order to lose weight, Brother Li tried a lot of products that were popular on micro-businesses, but even with exercise, they had little effect. In February of this year, he was introduced by a friend and came from a long way away. After considering his weight and physical condition, I decided that the most suitable treatment method was to perform a weight loss surgery called “gastric bypass surgery”. I drew an analogy with Brother Li on paper: “If a normal person’s stomach is as big as an apple, yours is like a dragon fruit, which is one circle bigger than others. I want to divide your stomach into two parts and form a gastric bursa at the top to limit food intake; at the same time, I want to connect the distal jejunum with this bursa so that food will bypass the large part of the stomach, the duodenum and the first jejunum, thus greatly controlling food intake and absorption. Of course, in addition to restricting food intake and absorption, the procedure also has the effect of changing gastrointestinal hormone secretion and intestinal flora, and these changes can improve glucolipid metabolism, thus playing a role in weight loss and sugar reduction”. The current international and national expert consensus is that gastric bypass surgery is the “gold standard” procedure for obesity and obese type 2 diabetes. What are the risks of gastric bypass surgery? After listening to my introduction, Brother Li had a relatively good understanding of the surgical treatment, but he was still concerned about the risks of the surgery, as it is not a minor surgery after all. In fact, although weight loss surgery is a complex surgery, its safety is very high, and the complications of surgery are lower than the “minor surgery” appendectomy and cholecystectomy in everyone’s eyes. According to a study published by Peter Benotti in 2014, a study of 15,7559 bariatric surgery patients showed that the surgical complications within 30 days of bariatric surgery were 0.1%, compared to 1.8% for the familiar minor surgery “appendicitis”, which is much higher than bariatric surgery. Of course, there are risks associated with any surgery, just like driving on the road. Some of the factors associated with the patient (including old age, high BMI, high blood pressure, sleep apnea, risk of pulmonary embolism, etc.) are like road conditions and weather. The risk is like a car accident, whether you are driving, walking or resting on the side of the road, there is a low probability of a car accident. The safety of the surgery is closely related to the technical level of the surgeon in charge. If the experienced surgeon in charge, the surgical team, the anesthesia team and the multidisciplinary team develop individualized treatment plans and strictly control all aspects, the risk factor will be greatly reduced, just like a strict “old driver” on the road, the accident rate will be much lower than that of a novice. After more than an hour of communication and explanation, Brother Li’s concerns about the risks of weight loss surgery were dispelled and he was full of expectation and hope. To be honest, in the past, it was difficult for me to fully communicate with patients for a long time in my highly hectic working condition. In recent years, I have started to explore more in the new environment, creating conditions to return to the essence of medical treatment, trying my best to give patients more and more time for communication and treatment. Because I believe that the understanding and trust between doctors and patients is the basis of all successful treatment. Next, Brother Li successfully completed the laparoscopic gastric bypass surgery, the whole procedure took about 100 minutes, and he could get out of bed on the first day after the surgery. The feeling of relief and the unprecedented medical experience made Brother Li write a poem to express his feelings.