6 month Post Op Visit White Blood cell was low. diganose as anemic, B-12 defecient,...

Well, I had my 6 month appt. on Jan 21, 2016 and went from a high point to a low point within minutes.  My weigh in was wonderful.  I weigh in at 301.  That is awesome because my journey started at 400 February 12, of 2015.  I have been working out 3 to 4 times a week and started lifting weights now.  I feel awesome, have more energy but my nutritionalist told me that I was still losing muscle mass.  I was also diagnosed as being anemic, vitamin deficient, B-12 deficient, and worse my White blood cell count has dropped.  Now I am scared as hell and they scheduled me to see a Hemotologist/oncologist.   Is this normal for bariatric patients.   please somebody tell me something.

Have you been taking your vitamins daily?  What surgery did you have?  With RNY the portion of the stomach responsible for making intrinsic factor is bypassed. This lack of intrinsic factor decreases the amount the body is able to absorb vitamin B12 after gastric bypass and to a lesser extent after gastric sleeve surgery.  Many of us have to give ourselves monthly (or weekly, depending on what your labs say) injections of B12.

Iron deficiency/anemia is common also.  Many of us do not absorb iron orally.  I see a hematologist regularly for iron infusions.  I feel 100% better after an infusion.  

Muscle loss is going to happen with rapid weight loss.  That is why it is so important to get enough protein in daily.  I average about 90 to 100 grams daily just to keep my numbers at the low end of normal.  Many WLS patients have to have much more.  

 I take two multi vitamins, 1500 mg, Calcium 120 mg iron with 800 mg Vitamin C (just to keep my ferritin from tanking too fast), 1000. mg Magnesium, 25,000 units of Vitamin A three times weekly, 50,000 units D3 once weekly, and a B complex weekly.  If I didn't do this, I would be deficient.  You can not just take your doctor's word that your numbers are fine.  You have to track trends and adjust vitamins accordingly.  I use a spread sheet to track my numbers.  I correct any downward trends before I get deficient.

Because it sounds like you have the tracking of vitamins down to a T, would you mind sharing the spreadsheet you use to track?  Does it indicate the "normal" range for each?  I'm just not sure what to be tracking and my Dr. said I'm doing well but added vitamin D and folic acid to my vitamin list.  I just want to double check all of my levels.  

TIA!

I just use a standard spreadsheet from my office program.  I fill in my numbers and compare them.  You can google the ranges if you need to, but your lab work should give you the ranges for normal.

Thanks for your response.  I must admit that I have missed a few of my pills on days... Not intentionally, just need to get a better routine going with that.  I no it's serious now, so making a better effort to get this in now.. As far as getting all the proteins in.  That has sometimes been difficult at times.  Now that I get full faster.  But I have started making a protein shake daily now( EAS protein) that I really like now.  Just hoping that everything turns out ok next week at the doctor.

Everything that Ros said, X2.  Wow, It was good that you went for your 6 month check-up!!! 

I take nasal B-12, I alternate between  Patch and Bariactive vitamins for calcium and daily multi-vit (I also used the chewables, but they gave me stomachaches).  My labs are good.

You will soon figure out what you need to do to get them in the acceptable range and keep them there.  This sounds stupid, but my vitamins are now like dessert.

About the muscle loss - even on a totally balanced regular weight loss diet, ~20% of the weight you lose will be muscle mass. Can be 25% with WLS.  Only weight training will rebuild it - aerobics, Zumba, etc will not. So you would have lost at least 20-25 pounds of muscle mass.  Further, if you do not each enough protein, then your body will canalabilze your muscles to support more important body functions - like brain function. 

I weigh 145 and target 85 gms protein per day - I am only 13% body fat, so I can tell you I get adequate protein.  Also, make sure the protein you are eating is complete proteins -if you are using beans, you must combine them with other foods to make complete proteins. 

The 85 grams came from a OH talk. If you need it, let me know and I will look it up for you.

I would suggest that, if not already doing it, to keep a log of what you are eating so your doctor can have that info and recommend any changes needed. 

Hang in there!!

Thanks for the info.  I eat Wendy's chili often along with bake chicken.  It was difficult some days to get in all the protein( over 100 grams a day). But I'm getting better on it.  Started making and drinking more shakes now... Hopefully after my doctor appt. on February 4, I'll be able to get questions answered and get down to a better routine.

First of all, congrats on the weight loss! 

Are you taking a multi-vitamin each day? How about B-12 sublingual and/or iron pills? If you are not already taking them, I would start immediately. I am 2.5 years out and have had my labs done several times since surgery. My B-12 and my iron levels are usually fine; however, my white blood cell count has been low ever since surgery. The surgeon tells me to follow up with my PCP and my PCP tells me it's low but not worrisome low (range 3.8 - 10.8 Thous/mcl). These are my most recent numbers:

July 2013: 8.3  (Surgery 7/26/13 - last time it was normal)

Jan 2014: 5.2

July 2014: 3.9

Jan 2015: 3.5

July 2015: 3.6

I have been below the range for awhile now with no explanation. My PCP is monitoring my levels for now. She has not mentioned a need for a hemotologist. I am not sure if it is normal in bariatric patients as  I haven't found much about this topic on the boards. I wish you luck and hope you get some answers. Follow up if you can after you see the specialist.

Lorie

Thanks I am taking citracal, b-1,, centrum,b-12 and b-50.  Still trying to get my protein in.  Been exercising 3 to 4 x a week and feeling good so I hope it all works itself out.  

Isn't Citrical calcium Citrate?  As I understand it we need to make sure we are getting calcium Carbonate, because citrate doesn't absorb well in the digestive tract?  Make sure your getting the good calcium that you need.  

I was having a problem with getting in all my supplements so I switched to Patch vitamins.  Can't tell you if they work yet, I'm scheduled for bloodwork in 2 weeks after using the patch for around three months.  I hope my levels are good cause I would hate to go back to taking all those pills.