My Gen Practitioner know nothing about the RNY procedure and the issues to monitor......

Have you had something similar with your GP. The last issue was Vit D levels and the recommended dosage of the supplement. I buy the megadose from Vitalady and he says its too much. My surgeon retired so he doesn't exist anymore.

I just want him to understand my bloodwork as it relates to mal-absorption. I stay extremely dehydrated and confusion sets in sometime when I am real low on water.

Jeff (15 yrs out this coming May 1st....)

Hi Jeff! I had to change pcp about 6 yrs after my RNY and the new dr. had no idea what the normal ranges were for a patient who had a bypass surgery. I found an article online that I thought would help him and he was able to gleam enough off of the file to know what to screen me for, what my levels should be with my procedure type, and where I needed to increase. He realized that I wasn't taking enough Vit D and increased me to 50,000 iu weekly, which is NOT normal for a normal patient.

This is the file I used https://asmbs.org/app/uploads/2017/06/ASMBS-Nutritional-Guid elines-2016-Update.pdf?/app/uploads/2008/09/asmbs-nutritiona l-guidelines-2016-update.pdf

Hopefully, it will help you in your situation. Congratulations on your long-term success and Happy Anniversary on May 1!

Thank you so much. This is good info that I will provide for him. Maybe he will benefit from it.

Jeff W Waldrop

You have at least two options. You can try to educate your doctor (if he's willing to listen and learn) or you can find another doctor. I have actually interviewed doctors to ensure they have provide the service I need. My current PCP is great. I had moved to a new area and needed a new doctor. When I called to make the appointment I explained my situation. I also came to my first appointment with reading material for the doctor and we spent at least 20 minutes just discussing the DS and my needs (very specific labs that needed to be run, etc. (he had never heard of it before but was willing/eager to learn).

Please try to get your dehydration under control. Do you have a condition that causes it or do you just simply not drink enough water?

What is most important is what your labs show; what you do to get there is less important (though there are some things, like calcium, where labs don't tell you much until you're very far off - the body strives to keep serum levels normal at the expense of your bones.)

Since your surgeon is out of the picture, you can probably find another surgeon who has their lab sheets posted on their website (ours does) which could give your PCP an idea of what labs to order. Ask around on the RNY section here. How extensive the lab orders are seem to vary widely from one surgeon to another, but I have seen other bypassers who have similar lab sheets to my wife's DS orders, which usually require 14-16 vials during a draw. You may also get some idea (for your PCP) by looking at what typical supplements different practices specify, though those are usually just the starting point for initial post op use which ultimately gets tailored for your individual needs, but should give a clue to your PCP as to what to expect.

Another idea that I see many do is to log and track your lab levels over time, noting in particular trends rather than just "normal range". That helps you get in front of a problem if something is trending in the wrong direction rather than waiting for the lab to flag something as out of the normal range. It is usually a lot easier to maintain levels with minor adjustments than to play catch up, particularly with the malabsorbing procedures. Be proactave and tell your GP that "it looks like I need to increase/decrease this supplement because of this trend". That's a lot better, and more convincing, than just saying that everyone else on the internet is taking this....

Depending upon what other health issues you may have (if any) that might require a specialist such as an endocrinologist, look for one who has good experience with bypass patients - I know some people who go that route to get some of the specialized follow up when their GP isn't amenable to it.

Good luck and keep the healthy side up

When my doctor retired, I ended up seeing a PA at another bariatric clinic in Dallas just for this reason!