Vitamin levels and negative effects?

I know vitamins and the concerns that come along with them are one of the most common topics on the board, however I did not want to hijack someone else's thread and thus opted to make my own.

My DS (revision from VSG - was a two stager from the get-go), was done June 2012 (so just shy of 9 months out), and I'm having some concerns.  I knew full well the undertaking that would be imposed on me with the DS when it came to vitamins, however I was not prepared for lack of pre-op care this time around from the Ontario government who approved my second surgery.

My revision was done out of province (my VSG was done out of country in October 2009) and as such I was essentially left orphaned.  My file was in limbo and my communications with the Ministry of Health went unanswered until recently.

Due to this my first round of bloodwork was not completed until 6 months out (should have been 3 months), and the second was not done until around 8 months (should have been 6).  However I have not heard or seen the results of either test.  The first set of results were seen by my family doctor who said a couple things were my low and then he sent me to an internist who ordered a parathyroid ultrasound due to it being I believe four times above what is considered normal.  Again, as they are not familiar with the DS and don't know what I'm dealing with I'm concerned.

I know I have not been able to follow a proper regiment and have gone significant periods of time since the surgery without taking anything due to being on a fixed income (disability) and having wasted money with Bariatric Advantage where they sent the wrong products and did not want to exchange or refund me.  They actually continue trying to rebill me for things even though I told them I was no longer interested in their products.

I was taking their chewable multi-vitamin for a while, but was limiting myself to 2 per day for 3 months.  I was using some over the counter chewable vitamins here and there.

I've been fighting with the Ministry of Health and the Ministry of Community & Social Services (disability) to try and have one or the other approve some funding for these necessary supplements either through drug benefits, discretionary funds (additional support under the special diet allowance for example), but it's a "talk to the other government department..." situation.

At any rate I've noticed tingling in my arms/legs (hands/legs will fall asleep easily), lightheadedness, significant cognitive and memory loss (I couldn't remember either of my mom's telephone numbers for example one day), I've recently started getting headaches again, bruising, etc.  I assume most of those symptoms are attributed to vitamin B12 and D deficiencies and potentially A?  

Today I've started experiencing what I can only describe as a vibrating sensation on the left side of my upper chest.  At one point while napping I thought I had placed my phone on my chest in vibrate mode.

Protein through food is not an issue for me as my stomach was still a normal size nearly 3 years out and was not touched during the DS revision.  So I make sure to eat high protein items so that I don't have to compensate with shakes.  

I have looked at the Vitalady packages and recommendations, but I get conflicting information.  Someone tells it what is offer is perfect, but someone else says it's too much and a lot of unneeded items.  I believe it breaks down to about a $100/month give or take.  That is 10% of my yearly income (rent takes up 85%) so while necessary it also doesn't fit into my budget as I noted and due to people taking advantage of the system in Canada/Ontario vitamins/supplements were removed from the ODB (Ontario Drug Beneit).  

I apologize this is long winded.  I'm just sort of unsure of what to do going forward regarding doctors, the results, and I know the simply solution would be getting the vitamins, but when you have $340 for all monthly expenditures after rent it makes things tough.  Under old guidelines there was room for up to $150 for the special diet allowance that could easily cover this and solve the problem, but government shenanigans always come into play.  Heck, I'm still fighting with the government for reimbursement for the cost of transportation, hotel stay and meals for my mother and I when we went to Montreal for my surgery.  I was told as long as we provided receipts it would be reimbursed.  Now they are demanding letters explaining why my revision could not be done in Ontario.

I should just contact a Toronto news outlet and see if someone wants to take up this story.  It was a news story on me the back at the end of 2008 that got the wheels in motion for for my VSG.  

Again, sorry for the length.  My thoughts tend to become longwinded at times when thinking out loud.  

Is there something I should definitely make sure I start taking immediately to be safe given my list of current symptoms?

I also forgot to mention that last Friday the government finally got back to me saying a new surgeon in Hamilton, a Dr. Chetty had agreed to take on my file.  I don't recall that surgeon name in Hamilton, but from what I gather he might have replaced Dr. Hong?  Not that it matter, just as long as he is versed in the DS.  It is why I requested going an extra hour out of my way as opposed to a Toronto hospital where no surgeons have DS experience.

I appreciate you putting up with this, heh.  I have a real fight on my hands with the two-headed beast that is the government.

It does sound like you are deficient in several important nutritional areas. In addition to what you intend to take, you might want to add a B-complex. B-complex should cover your other B vitamins but you'll still need the additional B12. high PTH may be coming from insufficient calcium and vitamin D3. You need to try to get your hands on dry D3 and take at a minimum 50,000IUs a day. That amount scare medical folks because all they're used to is oil based D2 in prescription form. Dry D3 won't be too much for you. Sounds like you might also need protein supplements for a time to get you back up to par. If your protein is low, your vitamins won't do their job either. Also check your potassium levels. Get copies of your labs and start tracking your levels on a spreadsheet. You can watch for trends and adjust your vitamins as appropriate. 

I use Vitalady's vitamins and her plan tweaked to go with my labs but there are ways to get vitamins from other sources but her plan is still what worked for me and it might be what you need now given your issues. 

Good luck with the new doc. Please keep us posted.

--gina

 

Hi Gina,

I appreciate the feedback and advice.

In a perfect world I'd have the funds to just over-supplement (by that I mean take a regiment that covers all my bases), but my daily living costs just increase and the lack of employment makes for a financial mess.

Is there a good resource online that outlines what is considered normal or optimal for DS patients when it comes to lab results?

And a number of tests were not covered by OHIP (Ontario Health Insurance Plan) so I said not to do them.  I mean one recent one was selenium.  Not sure how vital that is to my well being.  Perhaps the surgeon can order the test and have the blood drawn in a hospital lab.  I've heard some tests are covered in a hospital lab in Ontario and not in a doctor office blood lab.

If certain things are indeed extremely low is there any insight on what sort of uphill battle I might have to get back to normalcy?  

I assume protein is fine as I consume 120-160g through food.  I eat predominantly poultry and tend to favour turkey due to the higher protein levels.  So that easily gets me above the line.  So I'm just struggling with the vitamins/supplements and some days fluid intake.  I admittedly need to add water to my diet or at least make it a 50/50 split.

I'll definitely make sure to get copies of my labs and keep records myself.  I think it might be for the best to do it myself at the end of the day.

One topic I forgot to ask about; Could a deficiency in something be the reason for my bowels feeling like crap after getting up?  Most days it takes an hour or two before I feel normal.  But prior to that it's like a constant urge of needing to use the toilet.  Things overall in that department were not as bad as medical professionals claimed it would be, with only a few exceptions early out.  It seems most things have gotten substantially better from week to week.  I think I heard calcium can play a role in bowel functions?  I have some sort of liquid stuff from Costco that I have not used as of yet, and then the crappy chocolate flavoured chews from Bariatric Advantage (ick!).  Gonna have to suck it up and make use of them.

Is there any correlation between deficiencies causing slower weight loss?  I've noticed that it has diminished lately, and considering I am a big guy still (just under 400lbs) I expected to be a little further along this far out.

I have a lab targets document that Vitalady put together but it's in American measures. You can convert to the European/Canadian measures via online conversion tools. Link: http://www.gblcreations.com/Resources/Gina/VitaLadysLabsandT argets_11-2009.doc

B vitamins and B12 if let go long enough can result in permanent nerological issues. If caught early enough you can come back in a couple of months but you need the higher doses. Vitamin D3, calcium and PTH might take a little longer. High doses of dry D3 and calcium citrate, not calcium carbonate is what you need there. You may already have this but here's Vitalady's plan, just try to follow her recommendations by shopping sales or even better getting through your health system. Link: http://www.gblcreations.com/Resources/Gina/ProgramDRNY_ERNY_ BPDDS3-2010.pdf

The reason I suggest protein supplements is the bioavailability of whey protein isolate and to be sure your body is getting what it needs and not malaborbing so much. If your albumin and prealbumin labs are good, then you're fine.

I've heard that deficiencies can affect weight loss but I have no data. Sorry, no idea about the bowel issues--maybe just the volume of food you're eating? I really don't know. Sorry.

--gina

Hi Jeff, I was promised I'd get vites on script by my PCP, but I'm now not getting them and would never get them in DSer quantities. I was going to get B12 shots from my PCP but they want to keep my B12 levels at 7-800, whereas Vitalady advised that the like to see 1,500-2,000 so I'm going with their advice.

Also in the UK they only have calcium carbonate available on script not citrate so that's no good for us.

You need to demand a copy of your labs, as my PCP told me everything was fine whereas my iron's trending down so I'm going to work on improving that.  You need to check for yourself and compare to your last set of labs in a spreadsheet.

I'll PM you some other info.

While being low in B12 can cause the tingling...so can too much B6. Be careful with the B complex, maybe suppliment each one separately and just leave the B6 to the multi you take.

http://ods.od.nih.gov/factsheets/VitaminB6-QuickFacts/

I hope your chewable multis are not meant for children.  You need at least a double dose of multis every day.  You do not need chewables unless that's just your preference.  If you can't get calcium citrate, look for calcium apatite.  K deficiency may account for the bruising.  Are you taking K?

Just saw this Jeff and wanted to let you know that Dr Chetty is head of the medical bariatric program in Hamilton. He is not a surgeon and I'm quite sure that they do not have experience with DS. Hopefully they can at least contact St Joe's for some input when you see them? It's the only hospital with any real experience in Ontario.