9 Month Check up - learned some things

I had my 9 month checkup today - 169.2 - below my surgeon's goal! She said no more than another 20 pounds or so, and that's it. She also said I'm free to start a consult for PS but I think I'll wait a few months, I'm not in a big hurry. From my nut, I learned that I should be getting 1000-2000 micrograms of B-12 a week, no more. Even though B-12 is water soluble, it's the only B vitamin to store in your liver and she said that you don't want your liver to get overloaded. She said that same goes for protein - no more than 90 grams a day, although she said I'm not getting enough calories and I need to spread my protein out more. She wants me to add a protein bar, do half around 3pm and half around 7pm... I also found out I should be getting 100 milligrams of B-1 weekly. Currently, I'm taking a b-complex which gives me 48 mcg of B-12 and 3mg of B-1 (Thiamin). I've been taking it twice a week, but obviously, this won't cut it. That's the Total B from Vitamin Shoppe. So, I'm going to ditch this one (it tastes nasty, anyway) go back to the sublingual B-12 from GNC which had 1000mcg of B-12, and start a separate Thiamin... sigh... You almost need a degree in chemistry or biology to keep this all straight. Other than that, everything was good. I'm in a study they're doing on obesity so I get my blood drawn every time. This time, they blew out a vein (oh joy). I haven't had actual blood work done yet, though, that's at my 12 month, unless there's a problem, so I'll have that done in April for my May check up. Oh yeah, me, Mrs. You'll Be on BP Meds By the End of '05??? 110 over 70... Becky 287/169/Whatever!

Ummm, got a bit of a soap box here... They haven't done any labs on you yet? None? Rich had iron, Vit A and Follic acid deficiencies during his first 6-9 months post-op and needed his intake to be tweaked. I've had labs done every two months or so. I seriously disagree with your nut especially on the B12 and B1. I take 1,000 mcg of B12 a DAY. My B12 levels were just over the top of the normal range and my doctor was thrilled. She said "B12 is high but we really really like it high." I have to say that you are safer having higher than normal B12 and B1 then having them go low. If you are interested, the OSSG-Protein and OSSG-Nutrition groups on yahoo are full of folks that have been there done that with their vitamin levels. They are very very knowledgeable and many are long term post-ops. I learn alot from them. Unfortunately some of them had to learn the hard way through going through low vitamins levels which has caused permanent damage. Okay, I'll descend off my soap box... (deep cleansing breath...) Congratulations on your fabulous checkup. You have done marvelous, honey! Congrats on making it below your doctor's goal for you! Excellent! Kathy (who wishes she was just a shade under 170...heck I'll take 170 again...haven't seen that in a few weeks...grrrr...LOL!)

Kathy, see my reponse to Pat below... I'm truly torn. I truly trust my doc and her program, but it still bugs me when things vary from doc to doc so much. I'm going to continue researching this and email her on Monday to see what she thinks, as of course, it didn't occur to me to ask her when I saw her about what the nut said...

Hey Becky, good for you! Below your surgeon's goal? That's AWESOME! Keep up the great work! ~Wanda

Congratulations on your weight loss Becky. I have to tell you though that the message I get from my surgeon and nutritionist does not agree with what they told you about b-12 or protein. I don't know what to think or who is right. My surgeon does blood work every 3 months and so far I've done great. I will do my 9 month one this month. Lori

Hi! thank you for posting your Stats. One question, you indicated you shoudl be getting 100 milligrams of B-1 WEEKLY... did you mean daily or weekly? Thiamin as an extra pill... ask them about Benfotiamine (Benfotiamine (technically known as s-benzoylthiamine-o-monophosphate) is a synthetic fat-soluble form of thiamine (vitamin B1). It is highly effective at increasing plasma and cellular levels of thiamine diphosphate (TDP). TDP is the metabolically active coenzyme form of B1. ) Anyway... I have tended to try to keep my b-12 just on the UNDERside of my regular supplements... I would rather have the problems with a slight deficiency rather than a slight too much... too much causes liver damage and we're likely to be placing a strain on our liver anyway. By the way b12 info page with a picture which demonstrates in detail the absorption of b12 and why taking a pill form normally doesn't work for us... However I must confess I THINK.. don't know for sure.. but think they are describing how Cyanocobalamin rather than methylcobalamin is processed. We don't have very many of those INTRINSIC FACTORS to process cyanocobalamin in our stomach. http://www.naturalhealthconsult.com/Monographs/Methylcobalamin.html http://brain.hastypastry.net/forums/archive/index.php/t-43491.html And below is just a little information page I copied from http://www.ghchealth.com/jun-00.html What is the difference between Cyanocobalamin and Methylcobalamin? Methylcobalamin is the active form of vitamin B-12 that is better absorbed than many of the other forms like cyanocobalamin. Actually, Vitamin B12 comes in several kinds including hydroxy-, cyano-, and adenosyl-, but only the methyl form is used in the central nervous system. Here are some of the many uses and benefits of Methylcobalin The methyl form of B-12 especially protects nerve tissue and brain cells, and promotes healthy sleep. Methylcobalamin is important because it is delivered more efficiently to nerve tissues than regular B-12. Because of this, Methylcobalamin should be considered in the treatment of all neurological diseases. Based on its mechanism of action, it can be effective in slowing the progression of hard to treat neurological diseases like ALS, Multiple Sclerosis and Parkinson's Disease. Published studies show that high doses can help regenerate neurons and the myelin sheath that protects axons and peripheral nerves. Theraputic doses of Methylcobalamin have also been known to prevent and reverse numbness from nerve damage. Among the conditions which have responded favorably to Methylcobalamin are, ALS (Lou Gehrig's Disease,) Alzheimer's disease, Bell's Palsy, Parkinson's disease, Multiple Sclerosis, Brain Aging, Insomnia, Immune dysfunction, Chronic Fatigue Syndrome and Fibromyalgia, Schizophrenia, Diabetes, Impotence and Herpes Zoster (Shingles.) In one study of Alzheimer's patients given Methylcobalamin, the subjects improved their memory, emotions, and ability to communicate. In Alzheimer's or suspected Mercury amalgam related diseases (e.g. MS,) a hidden Vitamin B-12 deficiency has been found, even though the usual blood tests are normal. In one study of patients with chronic, progressive Multiple Sclerosis, 60 mg of Methylcobalamin resulted in clinical improvement in visual and auditory function, but not motor disability. Methylcobalamin may help prevent Parkinson's disease and slow the progression in those who are already afflicted. Parkinson's is caused by a destruction of brain cells that produce dopamine. Dopamine is produced from the amino acid, L-Dopa. Anyone taking any form of L-Dopa should also take from 5 to 20 mg of Methylcobalamin to enjoy the benefits of L-Dopa for much longer. For best results, it should be taken with Alpha Lipoic Acid. In a sleep study it was shown that Methylcobalamin reduced the amount of time the subjects slept, but the sleep quality was better and subjects awakened refreshed with better alertness and concentration. Methylcobalamin at 6mg per day for 16 weeks also improved sperm count by 37.5 percent. In other studies it was found that Methylcobalamin enhances and modulates lymphocytes (white blood cells) by increasing T-Cell (and especially T-helper cells) activity. In mice, several different kinds of cancerous tumors were suppressed by administration of Methylcobalamin for seven days. These included liver, lung and other tumors. In a study of Amyotrophic Lateral Sclerosis (ALS) patients, all given high dose (25 mg per day) Methylcobalamin showed increases in muscle strength. Methylcobalamin also slows the progression to AIDS in HIV + patients and helps prevent neurological problems. Methylcobalamin also balances the sympathetic/parasympathetic nervous system (calming when overexcited and stimulating when too calm). A therapeutic dose for conditions requiring Methylcobalamin would be a minimum of 1500 mcg and a maximum of 6000 mcg per day. No significant therapeutic advantage appears to occur from dosages exceeding this maximum dose; however, it is likely that beneficial physiological effects occur at dosages as low as 100 mcg per day, especially if this dose is given repetitively over time. Methylcobalamin is usually administered in divided doses three times daily. For every day prevention take 1 mg daily under the tongue. Dr. Edward F. Group III

Thanks for the info, Pat. I've been doing some research, myself, as well... I'm confused by my nut/doc's comments in comparison with other things I've read. I trust my doc and her program completely. St. Vs is one of the best bariatric centers in the midwest - it's a classified "Center for Excellence" by the ASBS and my surgeon is top notch, almost 90% of their practice is bariatrics. On the other hand, I read over and over things that Kathy pointed out, as well. One thing I DIDN'T do was compare my nut's comments with my doc. The nuts all work from the surgeon's recommendations, but I never actually said to my surgeon yesterday "My nut said XYZ, do you agree? What about ABC?" I should have. I'm the queen of 'afterthought'... I think I'll email my surgeon's office on Monday and see what they said. I also double-checked my vitamin updates. It says 100 milligrams Thiamin weekly. I recall she said they typically come in 250m pills and that I could just cut one in half... Dunno. Do know that I have to go get a different B-12 as the one I'm taking isn't as "complete" as it stated...

Early on post-op we were put on B1 as a separate supplement but weren't on B complex yet. We took like 1/4 of a pill a day. I honestly don't remember the dosage. Personally I think it is easier to remember to take something once a day then weekly. Then at our one month post-op visit, we were told to ditch the B1 and take a B-50 complex. Believe it or not, one of the big bariatric centers has on their website that patients should take Tums for calcium and use Carnation Instant Breakfast for protein. (Mind you many are adamanatly opposed to CIB because has milk sugar in it which doesn't really benefit people - and knowing my body and carbs it wouldn't work for me.) One of the gals on the OSSG-Nutrition or -Protein list wrote to them and stated the research and asked why. Their answer back was that these were "cheaper" for their patients who often cannot afford more expensive supplementation. They said that would rather have folks comply with that then not at all. Seriously! I really trust the folks on the nutrition/protein list because they have "walked the walk" - some long term post-ops some of whom have suffered damage from deficiencies. One member is Michelle who is vitalady and she is 10 years post-op, I believe. I do trust my physician, surgeon and nutritionist though I haven't seen a nut since early on. I've learned to learn for myself. I get a copy of all my labs and put it in a spreadsheet. I look for trends. If something is headed "south" I want to head it off at the pass so to speak. I use labtestsonline.org and other searches to learn more about what the results mean. While I do trust my physician sometimes, you just have to question things. Perfect example...I have had high PTH (parathyroid hormone) and elevated calcium off and on for a few years. It was suspected to be a parathyroid adenoma (tumor). The tumor causes one of the glands to work overtime giving off too much PTH which forces calcium levels out of the normal range. To do this...it grabs the extra from your bones. Very nice. My physician knows this but my first labs came back and the nurse from her office calls me and tells me my calcium level is high and to cut my calcium intake (supplements) in half. Huh? Waaa? Duh! I don't think so! I was very upset with the nurse. I wasn't very nice either. LOL! But they were completely wrong. My calcium levels will not come down if I reduce calcium because of the adenoma. And the calcium I take protects me from losing more bone. It will be high until the adenoma is found and removed (it is found and hopefully will be removed soon). Another example...the physician called and told Rich is Vit D and Vit A levels were low and to add an additional supplement. Whoops. It was just the Vit A. We had a copy of the labs. She made an honest mistake. So, I believe in being very, very proactive. Learn about your labs. Get copies of everything. Chart them. Look for trends. Question things. Ask questions. Research. Ask questions of those who've been there done that. This is all something we will have to live with and deficiencies can be harmful. Kathy