Bariatric and Metabolic Surgeon Laparoscopic and Cancer Surgeon

Having struggled with obesity for the last couple of years, things took a turn for the worse when Bob eventually experienced obesity-related diseases. He was diagnosed with type 2 diabetes 10 years ago. Our baseline A1C, which is the average blood sugar level in the last three months, was elevated at 7.6% (normal level is 6%). He was being maintained on insulin, 58 units in the morning and 28 units at night on top of maximum doses of two oral anti-diabetes medications. He is also on maintenance medicine for hypertension, non-alcoholic fatty liver disease (NAFLD), and increase in his triglyceride level. He is also suffering from Obstructive Sleep Apnea necessitating the need for CPAP or Continuous Positive Airway Pressure. His weight has also taken its toll on both of his knees and, lately, on his back as well, all of which required multiple surgeries. To top it all off, he also underwent coronary angiography with the placement of a stent for a single vessel disease. One by one complications of obesity crept in. You name it, Bob had it!
Bob and his wife, Lolit, decided to undergo intensive lifestyle modification through diet and exercise in the hope of battling obesity and curbing the numerous related diseases that Bob has already been experiencing. They found out that Bob had a difficult time controlling the amount of food that he was eating which resulted in no long-lasting weight loss. And due to the heavy burden of his weight on both his back and his knees which limits his mobility, he was having a hard time burning the extra calories through exercise. Several episodes of severe back pain requiring confinement in the hospital made them realize that enough was enough. They decided that it was probably high time to consider a more aggressive, effective and sustainable approach to his condition, a condition that has greatly affected his everyday quality of life.

Our journey together started on May 3rd of this year when a big jolly man accompanied by his ever supportive and loving wife came for a consultation at my clinic at The Medical City Clark. The initial consultation was followed by several more consultations eventually culminating with a definitive decision to undergo surgery. Determined to win his battle with obesity and its related diseases, we laid out the best plan for Bob’s profile. While the main objective of our surgery was to reduce his weight to a manageable level, Bob always reminded me that he was more concerned about alleviating the numerous related diseases that he had. His main priority was to alleviate his diabetes as well as to possibly eliminate the need for the CPAP.
The Big Day was set on June 2, 2017. This was a landmark case in the history of this budding medical facility, as this marked the FIRST-EVER procedure of its kind being performed in this hospital. He underwent laparoscopic bariatric surgery performed in the context of a multidisciplinary team. His recovery was not the usual course as far as length of stay and expected post-operative events. Nonetheless, he was discharged improved and a lot better compared to when we first began.

We started at 314 lbs (142.7 kgs) when he first entered our personalized weight loss program. He was down to 298 lbs (135.4 kgs) when they went home after surgery. I had tempered expectations as far as improving his diabetes was concerned and I was very open about this to them. All the parameters of complete resolution of his diabetes were against us– prolonged duration of DM, high pre-operative A1C, and the use of Insulin pre-op just to name a few. Our main goal really was to lessen if not totally eliminate his use of insulin and just maintain him on his oral medications.

But lo and behold, Bob’s blood sugar levels were so good that our endocrinologist had to discontinue not only his insulin injections, but both his oral meds as well. Bob is now free from ALL his anti-diabetes medications, starting 1 week post-op! God is truly great and He always makes the impossible possible!
While everything seems to be finally pointing towards a positive outcome for Bob, this admittedly is just the start of a very, very long and arduous journey. But with his determination, dedication and belief in the program that the entire Bariatric and Metabolic Team of The Medical City Clark- Diabetes, Nutrition, and Weight Management Services Center had laid out for him, we know that in the end, this journey will be worth it all. Although we knew that this journey will be full of struggles, we wanted Bob to know that the entire team is with him as living proof that this actually works!

Since Bob’s last follow-up with me (five weeks after his surgery), he has lost a total of 42.9 lbs (19.52 kgs), which corresponds to 37% of his excess weight. His body mass index (BMI) is now down to 35.2 (Class II Morbidly Obese) from 40.8 (Class III Morbidly Obese). Our A1C is now 7.1% from 7.6% prior to the procedure. We are now completely off insulin therapy which previously was at 86 units per day together with oral combination meds. Bob is now more mobile compared to when we started this journey. Despite all the positive outcomes thus far, admittedly, it is still a far cry from our set goals, but slowly but surely, we are getting there. There are a lot of areas where we can still improve and with Bob’s sheer determination and dedication, we hope that one day we will finally win this struggle against obesity and its related diseases.


Dr. Sir Emmanuel “Eman” Astudillo is a Bariatric and Metabolic Surgeon at The Medical City Clark and currently a co-chair at the Diabetes, Nutrition, and Weight Management Services Center. He graduated and finished his residency training in General Surgery at University of the East Ramon Magsaysay Memorial

Medical Center. He had his clinical fellowship training in Bariatric and Metabolic Surgery at the Body science and Metabolic International (BMI) Medical Center, China Medical University Hospital in Taiwan. He also had his training in Advanced and Basic Laparoscopy, AITS IRCAD in Taiwan.

He is a fellow of Philippine College of Surgeons, Philippine Society of General Surgery, and Philippine Association of Laparoscopic and Endoscopic Surgeons.

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