Blood Work Question .... RNY vs VSG

Wondering about post-op blood work.

Pre-op blood work was extensive for me....15+ vials.

Post-op, generally around five vials. I had VSG. I see other post-ops posting they have 15 vials drawn for testing. I assume it's because they had RNY and have to have more tests for malabsorption issues.

Am I correct in my assumption? I just had a surgeon's visit and asked about it, but we got interrupted and never got back to the question.

Great question Mary! My one year post-op was the same (about 5).

Mary, ditto for me (another VSG patient here). I'm coming up on three years post-op, and I don't remember ever having more than 5 vials drawn -- pre-op, 6 months out, 1 year out, 2 years out.

Four vials is pretty much what anyone having a yearly checkup in the US has drawn. I think sticking to that is a huge disservice for a WLS patient, no matter what surgery.

The first few years after surgery are pretty ubeventful, lab wise. We have stores of those things in our bodies, and they eventually become depleted. For those farther out from surgery, I've heard of almost as many deficiencies from VSGers as RNYers.

Part of that is complacency. It's tough to take vitamins and calcium 4 times a day, year in and year out. After the first few years of labs come back ok, we no longer treat it as imperative.

I had to push to have enough labs done. Why do vitamin K, I was asked? No one is ever deficient. I asked them how often they test for K. Never. I asked them how in hell they can say that no one is deficient if they never test for it???!!!

They tested, and my K was almost unreadable. Among other things, vitamin K is important for calcium use and absorption. And since I had bone issues prior to WLS, I insisted.

Not very long ago, almost no doctors routinely tested for vitamin D. No one is ever deficient, they said, so why waste a test? But when they did check regularly, they found that about half of all Americans were too low.

Things like K, copper, selenium, etc matter. Most of those 15 vials are for individual tests, where the first 4 or 5 vials they can do a whole series of tests.

I think all of us should be getting a full bariatric panel. Once a year. And track our own results on a spreadsheet, and watch for trends.

I agree Grim. I had never been tested for Vitamin D pre op and when I had my preoperative labs done my value was the lowest they had ever seen. The 15 tunes of blood sucks but the peace of mind from knowing what is truly going on with your body is priceless. I also have a spreadsheet with my actual values--PA always tries to just say they are all fine but I insist on her reading me the actual number values so I can have them in my record. I used to hate to be seen as a nuisance or a bother but as I've aged I've realized that it's my right to ask for what I need from her--after all technically she's my employee.

My thyroid is tested every 3 months due to Hashimoto's - that's six tests alone there, maybe seven? My bariatric labs are every six months and include almost all vitamins, plus several minerals. Note that ferritin and PTH are better to examine iron and calcium, but aren't standard, either. You have to ask.

If you have a malabsorptive procedure, I'd argue it's absolutely vital to get labs done pre-op and then once every 3 months after for the first year. It's the most important for DS patients and RNY patients, but VSG peeps should at least always get several checked. As Grim mentioned, many things are never routinely tested for which it's more prudent to do.

Once every three months may sound annoying, but so is anemia and osteoperosis, or neurological side effects.

Even with the VSG, it's good to test for many deficiencies, as we eat far less than pre-op.

I appreciate this advice from you, Grim, and others. However, I don't know which tests to insist upon. If I ask my physician to order a "full bariatric panel", will that encompass all of the tests needed? Is there a standard "full bariatric panel", or does this very by physician? I see from posts here that ferritin, PTH (what's that?) and Vitamin K may not be included but should be insisted on. I am concerned about my own ignorance, and want to correct it, since I'm definitely the one who will suffer if things are overlooked - and I don't want to suffer! Is there a good, accurate, comprehensive list of vitamin and minerals which RNY patients should be tested for published somewhere?

I started preparing for my surgery in 2016, and had bloodwork drawn then. But since it was so long ago I will have to have blood drawn again next week, prior to my 6/12 surgery. Last year's blood draw certainly wasn't 15 vials! I don't remember how many were drawn, but I doubt that it was more than 3 or 4. 15 vials, sheesh! But if that's what it takes to give a good baseline picture, then that's what I want.

PTH is for parathyroid hormone. If you are deficient in calcium, it will show here long before the other blood tests. For the VSG, eh, it's nice but not necessarily mandatory. It's absolutely mandatory for DS and RNY patients, or anyone with malabsorption, as you want to catch such lapses sooner rather than later.

Full bariatric panels vary by physician. For RNY, I'm not as familiar as the DS and the VSG's requirements. Yearly minimum, get a CMP and CBC, lipids, vites A, D, B6, B12, folate. Maybe more often depending on if you are deficient. 3-6 months depending get PTH with calcium, iron, ferritin.

For some bizarre reason they almost never order ferritin for RNY patients and you should really always have it due to anemia issues. The reason it's important is because serum ferritin notes how much iron is stored in the body, which is more accurate to determine long-term deficiencies - ferritin is a protein that stores iron. If you ingest iron it may temporarily raise some of the other blood tests, so ferritin is more reliable in seeing what your body actually needs (or doesn't) as it isn't affected by short-term ingestion. DS and RNY patients, or even non-WLS patients with bypass-like procedures in the same area of the intestines, should always get ferritin tested, IMO.

Dunno about copper and zinc; I know definitely for the DS, so I'd imagine the RNY would benefit too, depending. Someone with an RNY would provide better commentary in general; the above is just based on quick note perusals.

sorry for the tangent >.>

Thank you Donna, for explaining. I too am hypothyroid, though Hashimoto's has never been specified. I only have my blood taken once a year for this.

The order that I have for my upcoming blood work reads as follows:

CBC (includes diff/plt)

Comp metabolic panel w/adj calcium, plasma

Prothrombin w/INR + partial thromboplastin times

Vitamin B1 (thiamine), blood, ic/MS/MS

I am going to ask my nurse friend about these orders, as I have no idea what most of this means. The biggest fear that I have about my upcoming RNY has to do with developing deficiencies.

The prothrombin tests are standard before most elective surgery. It's checking your blood clotting time.

Thyroid non-WLS tangent: I tell everyone to get thyroid antibodies checked once for kicks if you can afford it; most who are hypothyroid are for autoimmune reasons. The reason it's good to check is that those of us with Hashimoto's are prone to getting thyroid nodules, and so then it's good to check for those. We are at a minimally higher risk for thyroid cancer. Hashi is also the most common cause of hypothyroidism, and we benefit from T3 supplementation which is not standard protocol. Knowledge is power, or something >.>

That's not bad. I'd get vitamin D done for sure if you live somewhere that's low sun, especially. Being obese we are already prone to deficiencies. That is a general rule for anyone obese, though, WLS or not.

Also, it might be good also to get iron and ferritin checked for a baseline measurement, then re-check post-op. Again, I am not an RNY expert, and that is the surgery I know the least about. I'm more inclined to overtest, but that's because I'll be revising to the DS so I'm acclimating to that lab schedule.

If insurance covers it, or if you can afford it, it might be good to get a DEXA scan pre-op so you can compare future scans to track bone loss. That is one thing I regret not doing.