Doctors and Nutritionists!
on 5/30/07 4:25 am - NY
do the nuts.
I hear
ya!!
Read as much as you can as you can and make an informed choice. Go to you're follow up apts, get labs done and stay informed.
All the best to you!
@----}-------
345/195/165
Anchor cut Tummy Tuck
with muscle tightening 6/20/07
S.L.
I hear your frustration, and can appreciate that having had the same experiences over the past 5 years. I decided to not takeit personally and do as much research as I could, feeling knowledge is power. I came to accept the following things to avoid my black/white thinking: Surgeons are expert at what they do, surgery; they may know about nutrition but for the most part that is not their specialty even if a bariatric surgeon. Most surgeons are only following their patients for urgery issues not metabolic and nutritional issues, they tend to leave this to a bariatrician, clinical nutrition DOCTOR or a nutritionist/dietician or sadly a Primary care provider who is a generalist and knows a little about a lot of things. Nutritionists/dieticians may not be specialized in bariatrics, some are not even familiar with what anatomical changes an RNYer has! This is not in their typical education (*I have asked nutritionist as well as local university I went to NP school at, and know it was not in ny of my nutrition clsses in RN or NP school or even in my texts! 1990-2002 I attended colleges) it may be more so now as bariatric surgery explodes following closely the obesity epidemic now that over 66% of Americans are overwt/obese. Some are willing to learn but the literature is scare to tell you the truth! With centers of excellence now coming to the forefront I hope this will foster multidiscilinary treatment teams (bariatric surgeon, nutritionist, bariatrician MD, exercise physiologist, psychiatric providers, bariatric nurses, etc). VS the fly by night practices that openedup in past 5+ yrs w/o f/up sadly is common! many MO pts are so desperate they do not research their surgeo, program etc, they think now and not longterm, I know some people and its common who see their surgeon 1-2 and then no one else ever, how scarey and sad! I realize the more surgery done the more knowledge and research we will have despite being aroun since 1960's RNYs quadrupled in 5 yrs 1998-2002: I believe over 150,000 were done in last yr or so...so statistically deficiencies will be seen not as rare because of sheer volume increase!
http://www.ahrq.gov/news/press/pr2005/wtlosspr.htm
Press Release Date: July 12, 2005
**THE number of Americans having weight-loss surgery more than quadrupled between 1998 and 2002—from 13,386 to 71,733—with part of the increase driven by a 900 percent rise in operations on patients between the ages of 55 and 64, according to a new study by HHS' Agency for Healthcare Research and Quality.
I remember that as individuals how ONE person's body responds to a surgey can be vastly different from anothers. Their can be GUIDELINES butno had ad fast rules because we are unique gentically. Some pts have no deficiencies and take nothing, some take mega doses and are still deficient, WHY? We simply do not know. Preexisting comorbidities may be a pieceof that, age, gender, ethnicity. Not all RNys are the same, how much small intstine is bypass can differ greatly, there is so many variations as well, Fobi pouch w/ silastic band around stoma, Sapala-wood micro pouch -2 cc vs typical 15-30cc pouch,, I know many w 25 cm bypasses and others with 150cm and all are called proximals! A standard 100cm bypass is 39 inches or 3.2 feet bypassed leaving their common channel where nitrients are absorbed to be 18 feet.
Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements*, though in varying doses. We are all missing the stomach and its normal digestive function. Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time. Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight.
* THE BASIC 8***
Protein, Iron, Calcium, A, D, E, Zinc, B12
I know that suppliments are based on las, that we all need for life maybe every 3-6-12 months depending on HOW OUR BODY REACTS.....which can change from 1 yr to 3 yrs postop etc, I now mine did! I realize they are discovering more issues a they go, such as copper and selenium they are finding as deficiencies as well ad now more are testing these things. Make sure you are getting these labs: or a combo of depending on your needs.
COMPREHENSIVE METABOLIC PROFILE
LIPID PROFILE
PHOSPHORUS – INORGANIC, URIC ACID
CBC w/ diff
B-12 & FOLATE, B-6 & Thiamine (B-1)
IRON, TIBC, % SAT, FERRITIN
VITAMIN A, E & D (25-hydroxy)
THYROID PANEL (T3, T4, TSH)*only initially unless suspect.
ZINC, MAGNESIUM, Selenium, Copper
SERUM INTACT PTH
Homocystine, MMA
HGB A1C (only if diabetic or suspected)
DEXA SCAN every 1-2 years depends on results!
Diagnosis:
579.3 post-surgical malabsorption
268 vitamin D deficiency
269.2 hypovitaminosis
268.2 metabolic bone disease
244.9 hypothyroidism
FROM "UPDATE: Surgery for the Morbidly Obese Patient" by Dr. Mervyn Deitel MD CRCSC FICS FACN DABS INTERNAL FEDERATION for the Surgery of Obesity Editor in chief OBESITY SURGERY & Dr.George S.M. Cowan JR, MD FACN Professor of Surgery, U of Tennesseee College of Medicine. 2000 ISBN 0-9684426-1-7
CH 25 limb Lengths (oh how they can grow!)
Pg 271.
As general surgeons we know that mid-gut volvulus resulting in the loss of as much as 50% of middle small intestine does not result in permanent nutritional harm. Patients usually adapt to the loss and are able to maintain adequate nutrition while experiencing only one or two extra, soft bowel movements daily. Thus like the Kidneys and Lungs, the average small intestine possesses approximately ONE-HALF of its length as BACK-UP or redundancy, if the remaining length is normal and an ileocecal valve and intact stomach are in place. The small intestine has the ability to more slowly adapt to even shorter lengths of intestines if necessary. This explains why Brolin's & Cowan's series of extended alimentary limb lengths each filed to increase long-term weight loss. Their patient’s common limbs were too long, after intestinal ADAPTATIONS of ELONGATION, DILATION, ENLARGED FOLDS (Valvulae conniventes) and LONG HYPERPLASTIC VILLI occurred. So depending on your adaption may effect your recommended suppliments!
I recommend this book:
http://www.bariatrictimes.com/obesity-medical-books.cfm
Micronutrition for the Weight Loss Surgery Patient Price: $49.95 (plus $5.00 shipping and handling) Author: Jacqueline Jacques, ND Synopsis: Nutritional medicine is really a specialty unto itself, and few physicians today are properly prepared to manage complex cases such as those that may
present in weight loss surgery patients. Unmonitored nutritional deficiencies can leave weight loss surgery patients vulnerable to both acute and chronic
conditions with variably reversible to permanent physical damage. This book is intended to offer a practical manual for prevention, diagnosis, and treatment
for surgeons, primary care physicians, dietitians, and others caring for weight loss surgery patients. Clinicians using this book should ultimately find themselves
better equipped to make educated decisions regarding nutritional management of their weight loss surgery patients. About the Author: Jacqueline Jacques, ND, is a Naturopathic Doctor with more than a decade of expertise in medical nutrition. Dr. Jacques has spent much of her career in the dietary supplement industry as a formulator, speaker, writer, and educator. She is the Chief Science Officer for Catalina Lifesciences LLC, a company dedicated to providing the best of nutritional care to weight loss surgery patients.
I have several articles and a chapter from obesity surgery text that Id gladly share on this. Cynthia Buffington, Ph.D. has done a lot of research she has work written in beyond change http://www.beyondchange-obesity.com/ a good resource to read $25 yr subscritption and other places. Bariatric times is also online and has archives here: http://www.bariatrictimes.com/article-archives.cfm As for caffeine, we know it is a gastric irritant no ifs ands of butts, so if one wants to use it go ahead but risk ulcers, dehydration early on and it interferes with different vitamin and mineral absorption so be careful when u drink it, also many feel it stimulates appetite and well who needs that?! What people put in coffeee can be an issue also defeating the tool with calories we drink.... Not all rnyers dump less than 50% do also so may tolerate sugar sadly..its a guesig game at times, frustrating but true. Dehydration i issues early worisome early on it can be fatal, later on as pouch heal we can drink easier so not such a risk... Yes and all health care providers have biases so knowing that, some make money form suppliments they sel in their ofice also, I know there is no one size fits all so concept of a bariatric vitamin doesnt make sense to me to spend mega bucks when good old generic walmartsworks for me and my labs, if we all had same issue then Id say yes but we dont... ok off soapbox! :-)GGT, LDH, Prealbumin
So the long and short of it is ther eis no one size fits all rule to tell us, there are guidelines that do change with research this is true in any field I have found as a medical professional. No never takle someones word as gospel, critically think for yourself with guidance of healthcare providers to make an educated and informed decision for YOU. BE aare of risks longterm and make sure you follow up with recommendations labs, suppliment and such many avoid apts feeling they are normal at 1 yr out how wrong that can be.
What type of vit also makes a difference, forms of iron differ by individual how it is absorbed some are ok on ferrous sulfate othes need carbonyl or polysaccharide or iron chelate, some need IM iron others ned ironinfusions...again our bodies differ.
I finally offer there is typical and a wide range of possibilities know the common 8 we need to watch and how they can even vary...how well your body adapts to the surgery is key.
Do what works, feels right and know at 1 yr and 3 yr and 5 yrs it may be ery different!
I stopped chewables 1 mo out when I could swallow pills, I do generic walmart multivit one a day too many and we can OD on vit A! Iron I need but too much can be harmful so I have to watch my labs, I do daily B12 ublingual a friend needs it only 1x week, why I topped ependign energy to gues and accepted I needed it dail, I choose calcium citrate as what I need due to rsearch it is esier absorbed b/c I do not have acidic environment for caclium carbonate to be absorbed, why do some surgeons still rec. tums ? WHo kows, not al are up on reasearch I guess.
Do what is right, if u want any articles let me know at [email protected]
PS at 5 yrs out I still do a protein shake or 2 a day, my labs are great...when I didnt do them I was protein deficient but that was at 1 yr out I never stopped them to see if it matters now! many say eat protein they worry about drinking caloreis to gain wt I guess.
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
