Mrs. Nelson, a 58-year-old woman, came to the clinic to discuss her frequent “spells.”
Her spells have been occurring for the past 18 months, and she has not been able to figure out what causes them. The spells consist of a sudden onset of sweating, lightheadedness, dizziness, weakness, and difficulty concentrating. The spells can occur at any time of day but usually do not start until about 2 pm. The spells have occurred overnight and usually about 1 to 2 hours after she goes to bed. She reports that most of the spells generally occur within 1 to 2 hours after a meal or snack. The last time a spell occurred was during the previous week after she had eaten popcorn in the evening. She started sweating and became weak about 1 hour after eating. She felt better about 30 minutes after consuming yogurt and crackers.
Her medical history includes dyslipidemia, borderline hypertension, obstructive sleep apnea prior to significant weight loss, and depression. She had Roux-en-Y gastric bypass surgery 4 years ago. She was most recently seen by the bariatric surgery providers 2 years ago.
- Weight at time of bariatric surgery: 108.9 kg
- Current weight: 73.6 kg
Typically, she eats a regular diet with 3 meals and 1 evening snack daily. She reports a new intolerance to milk in the past year and has transitioned to soy milk. She otherwise consumes water, coffee, tea, and sugar-free, fruit-flavored drinks. She consumes at least 10 cups of fluids daily. Her protein intake includes an instant breakfast drink, peanut butter every morning, protein within frozen single-serving microwave meals, and protein bars. She eats at restaurants for her evening meal 1 to 2 times per week. She consumes alcohol no more than 2 times per week (typically 5 ounces of wine per serving).
Presence of GI symptoms related to bariatric surgery
She has mild constipation, but she does not take anything for treatment. She denies nausea, vomiting, diarrhea, gas, or bloating.
She walks on the treadmill at home 3 to 5 times per week for 30 minutes after work in the evenings.