Being Serious For A Change...
I know that you all know that I've had issue with side pain. No one really knows what it is and my wonderful surgeon has done hoardes of tests to no avail. He is completely baffled. But the good news is that the pain is not consistent each day anymore. I've actually had good days in the past couple of weeks where I had little or no pain. I have no explanation for it but I'm not going to complain. I'll just monitor this and see how it goes.
But...uh oh...here comes the serious part. I'm having neuropathy in my feet. My toes tingle and I don't mean the way they feel when Rich kisses me either. This isn't good. My left foot seem to be slapping the floor and just feels funny. My surgeon is very, very concerned and wants me to get blood work done which I was due for anyway but he also wants me to go see a neurologist.
I have been taking my vitamins religiously since surgery. Perhaps a day here or there I didn't but overall I'd say I've been 99% compliant. I take more than alot of you yet I still find myself having issues. I really suspect that my problems are due to B12 (or other Bs) not absorbing well. Just because we are told to take B12 sublinguals doesn't mean our bodies absorb enough of it or that our bodies utilize it correctly.
I will be seeing my PCP on Monday and get my blood work done and I'll discuss seeing a neurologist with her. I'd like to find out the blood test results first, I think, but we'll see what she says. I was planning on asking her to get on B12 shots anyway and for Rich too to try to help prevent neuropathy but I guess I'm already there. I do believe that this can be reversed. This has only been going on for about a week or so.
I cannot stress the importance of drinking protein shakes each and every day. Notice that I say "shakes" and not "shake". Some doctors tell their patients to stop shakes at 6 weeks out and get their protein from food. Well, the bottom line is that without stomach acid...our protein doesn't get well converted to amino acids that we need therefore we don't absorb much of the food protein we take in. Protein shakes are predigested - meaning they are already amino acids so you drink them and they are readily absorbed. There is a bit of controvery on whether our bodies absorb more than 30 grams of protein (from shakes) at a time. Wisest thing to do is to limit your intake to 30 grams or less at a time at most and leave the rest for another "feeding". My surgeon believes in shakes for the rest of our lives and I do share that feeling.
Our blood levels for protein may appear fine but what is important is what is going to happen to our bodies a year post-op, two years, three years, etc. Some find that their body loses the protein stores and ends up using up valuable muscle tissue. We do NOT want that to happen. The key is protein shakes! They are made from the most bioavailable protein to our bodies (what can be utilized the best). BTW, the protein puddings are not as bioavailable since they are "soy protein" and are more like regular food when processed so I wouldn't count them as a protein supplement.
I cannot stress the importance of learning about what vitamins you need. DO NOT take what your surgeon says as gospel. There is alot of misinformation out there. Just like the calcium carbonate (Tums, Viactiv) versus calcium citrate controversy that crops up. Calcium carbonate requires stomach acid to be absorbed. We don't have it therefore calcium citrate is the calcium of choice for post-ops. I do have the National Institutes of Health study on this if anyone is interested. Yes, calcium citrate is pricier than the carbonate but we have to take what will be absorbed. Remember, our bodies only absorb about 500 mg of calcium at one time so split up your doses. Most folks should be taking somewhere in the range of 1500-2000 mg a day.
Also, be aware that a blood test showing that your calcium level is fine is NOT ENOUGH information to know that your aren't losing calcium from your bones. Calcium levels in the body are regulated by the four parathyroid glands that reside by the thyroid. That is their only job - calcium regulation. If you aren't getting enough calcium in or are taking the wrong form of calcium and it isn't getting absorbed...your parathyroid glands will get busy working their butts off to bring your calcium level into normal range. How do they do that? They will steal it from your bones. I am not joking! So when you get your blood work done - your surgeon should not only be checking calcium - he should also be checking PTH (parathyroid hormone). You can have a "normal" calcium level and a high PTH which would indicate that you aren't absorbing calcium well and that you are losing from your bones. Also remember that as post-ops we should be having bone density scans yearly to help identify bone loss!
(FYI, I know alot about the parathyroid glands from personal issues that I've had prior to WLS.)
Now, lets talk about my B12 levels. I looked through my blood work and it looks like going to multiple doctors and having each run some of my labs - B12 level was missed last time. FYI, a B12 level can be completely normal but your body could not be using that B12 correctly. I suspect that is going to be my case. How will they know? Well, obviously from my symptoms..numbness, tingling, slapping foot on the ground... But, above and beyond the B12 level, there are two other blood tests that should be run....MMA and homocysteine. They in addition to the B12 level will tell if your body is using the B12 that it has. In general, you cannot overtake B12 within reason, of course. If your level is a bit on the high side and your doctor says to take less - I wouldn't do it. Not in your life. Heck, this is your life I'm talking about. A level higher than the lab's normal range isn't toxic - it might actually be good for you assuming your body can use the B12 you have.
What happens if your sublingual isn't doing it? You'll go on B12 shots. Some of you already are. Good for you. I'm going to ask to do my own shots. Heck I gave myself insulin for 5 years, I can do B12.
In summation, I'm trying to tell each and every one of you...that you need to be very proactive in your own care here! Remember, bariatric surgery hasn't been around forever and there are only so many long term patients to learn from. As you can probably tell, I'm an information junkie. I've been researching alot of this for a long time and I keep my ears open and eyes peeled for information. I've learned to filter out as much of the misinformation as I can. I have been trying hard to learn about my own lab tests so that I can read them. I know on my last tests one of the values was slightly elevated. Well, I learned that could possibly be an early sign of anemia. I do trust my PCP and my surgeon - but I want to be sure to ask about things so that I can protect Rich and I both from complications down the road. Yet here I am with them...
A very heartfelt,
Kathy
Kathy 
Kathy,
I just wanted to thank you for your consistently well-written, well-informed posts. I also wanted to express to you that I hope you get this all straightened out, because although no one deserves to have problems, you're being as compliant as I think you can be. I'm fairly sure at this point that I've made it clear I'm not nearly as compliant.. although I've been really good this week so far, and I'm hoping to maintain good practices and make them habit. So thank you again for putting the information out there.. you also just made me take another vitamin. 
I wish you and your family all the best.. Happy Thanksgiving.
-Jasmina
I wish you and your family all the best.. Happy Thanksgiving.
-Jasmina 
Damn, honey. This sucks. I'm so sorry you're having to deal with this. I can't imagine how worried you are right now.
Neuropathy CAN be reveresed and if that's what it is, I'm convinced you'll beat it, but I'm sorry you have to go through this ordeal. Try to stay positive, keep us informed on what's going on, and know that you're in my thoughts.
Becky
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