Recent Posts
Topic: RE: Post-op Depression
Hello Pat,
I think I am prepared for the depression, at least I know that I can be helped via med's until I can get better if needed. I had my Dr. consult on Saturday and I feel more at ease with the thought of doing what I need to do and have the surg. My husband is against it. I know I need it to stay out of long term illnesses down the road and a wasted life, unhappy and in pain. He thinks I should just be able to stop and eat right. I have PCOS and have dieted for 33 years! Then he tells me, what if I have the surg and get so depressed I blow my head off".
I think I will be having the life saving surgery and pray for happiness.
Thank you for your help, I am very glad to hear your feeling better and enjoying the benefits of your surg.
PS. I think you are pretty in your before pic, I bet your supermodel in you after!
Topic: RE: Post-op Depression
Hi Sandra,
I am doing fine now. I had depression for about 2-1/2 months post-op that did lessen as I adjused to the drastic chage in eating habits. My doctor said that I had an especially bad case of post-op depression. I was able to work during the transition and my family just had to be tolerant of me. I am happy to say that I feel great today both physically and emotionally and have lost a total of 77 pounds in 4 months. I can finally say out loud I am glad that I had the surgery. So do not fret...if you do get post-op depression it will pass and you will feel better!
Thank you for your prayers and I wish you the best!
Pat
Topic: RE: Post-op Depression
Hello,
This has been my biggest fear. I am 46, same diet history as yours.....Please let me know how you are doing, I hope I am not being to forward, but I really would like to know if the depression is "livable" I don't know if that makes sense to you, can you still function? has it affected your job? your daily everything????
I figure if I get as far as having the surgery and can't handle the post op side I will just end up on heavy anti depressants. I pray not.
I also pray that you are improving every day and that you will be a very happy woman soon.
thank you
Topic: Hypoglycemia information for all-xpost
Some folks have written about developing hypoglycemia after their surgery.
I had my RnY in May, and only heard about the possibility of developing hypoglycemia a few days before my surgery.
My husband is an endocrinologist with several patients & staff (plus me) who have had wls. He is concerned about the possibility of hypoglycemia and has been following the published medical literature about it.
He wrote the following up and gave me permission to post it to this list, hoping that it might be helpful. It might be useful to print it out and show it to your doctor if this is something that you might be developing.
This certainly should not be used as a medical diagnosis; only your doctor will be able to do that accurately.
Therese
*****
Hypoglycemia can complicate gastric bypass surgery (GBS) for a small fraction of patients. Until recently the only reported remedy was partial pancreatectomy, the hypothesis being that increased secretion of incretins (intestinal hormones that stimulate insulin secretion) had caused overgrowth (hyperplasia) of the beta cells that secrete insulin.
However, researchers in Los Angeles have shown that hypoglycemia after bypass surgery is NOT always accompanied by islet cell overgrowth (1).
Furthermore, a couple of other possible treatments have recently been reported.
First, a group in Minneapolis (2) showed that hypoglycemia in three affected patients developed only after a high carbohydrate meal, which ran blood sugar up over 200 mg/dL and released very large amounts of insulin, which then pulled the blood sugar down too far. In contrast, low carbohydrate test meals did not produce much change in insulin or blood sugar.
Second, and most importantly, a Swiss team (3) observed that severe, disabling hypoglycemia after GBS occurred only in patients with with loss of restriction of the gastric pouch. They reported on 10 consecutive patients, of whom 9 were cured simply by surgical placement of a silastic ring or adjustable gastric band around the pouch. Only one patient failed to respond to re-establishing pouch restriction, and had to undergo distal pancreatectomy after all. The followup period was 5 to 19 months. There was no mortality and only 1 patient had any morbidity.
These measures may not always work, but they should certainly be tried before resorting to surgery on the pancreas. There is also a medication that inhibits insulin secrtion, diazoxide, which could also be tried as well.
References.
1. Diabetes Care. 2006 Jul;29(7):1554-9. Hyperinsulinemic hypoglycemia after gastric bypass surgery is not accompanied by islet hyperplasia or increased beta-cell turnover. Meier JJ, Butler AE, Galasso R, Butler PC. Larry Hillblom Islet Research Center, UCLA David Geffen School of Medicine, 24-130 Warren Hall, 900 Veteran Ave., Los Angeles, CA 90095-7073, USA.
2. Obes Surg. 2007 May;17(5):592-4. Hyperinsulinemic hypoglycemia developing late after gastric bypass. Bantle JP, Ikramuddin S, Kellogg TA, Buchwald H. Division of Endocrinology and Diabetes, Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
3.Obes Surg. 2008 Apr 26. [Epub ahead of print]. Severe Recurrent Hypoglycemia after Gastric Bypass Surgery. Z'graggen K, Guweidhi A, Steffen R, Potoczna N, Biral R, Walther F, Komminoth P, Horber, F. Berner Viszeralchirurgie and Schweizerisches Pankreaszentrum Klinik Beau-Site Bern, Bern, Switzerland.
Lawrence E. Mallette, MD, PhD
June 24, 2008
Topic: RE: For those with pernicious anemia after wls-
http://en.wikipedia.org/wiki/Pernicious_anemia
http://www.nlm.nih.gov/medlineplus/ency/article/000569.htm
http://www.nhlbi.nih.gov/health/dci/Diseases/prnanmia/prnanm ia_what.html
http://www.umm.edu/blood/aneper.htm
If you go to google and run a search on "Pernicious anemia" you will find a world of information. As always, use the most reputable medical sites.
First, since you are post WLS, we KNOW without question or testing that you lack the ability to possess the intrinsic factor that allows the body to absorb B12. That part of your intestines has been completely bypassed so you will never again absorb B12 by food alone. Some are successful with the sublingual tablets. If you notice, the dosage is usually 2500 which is over 40,000 (fourty thousand) percent of the RDA. It is believed that some are able to to have success with this treatment because the dosage is so high that the body is *forced* to accept some of this component that is introduced into the body. The actual RDA of B12 is typically easily achieved through diet unless one has a disorder that prevents the body from producing the IF because of disease or as is the case when a portion of the bowel is bypasses as in the post-op gastric bypass patient.
Aside from the research I did on what causes PA, I also studied the treatment of PA along with lab tests, readings, studies, means, etc. My PCP didn't agree with the research I had regarding treating the anemia. It's important to remember that doctors (especially PCPs) cannot possibly keep up with all the current information on disease/illness/etc. and treatment. To do so, he'd never be able to see patients! Also, they are "general" doctors and not "specialists". The best treatment for any blood disorder will obviously come from a Hemotologist (though he can't know it all either! LOL) Anyway, my PCP wanted to take a much more conservative approach (injections once per month) which I believed would not help my stores quickly enough and it would therefore take me longer to recover and feel better. I had to "encourage" a better treatment plan than what he wanted but I got what I wanted and it has worked. The suggested treatments vary - some physicians think oral / sublingual B12 is sufficient and it may be for some but I felt like trying that hadn't worked for me. It does take 2 years for the liver to become depleted of its B12 stores which is why we start to see PA in WLS patients around the 2 year mark. The concensus regarding treatment of PA in post op WLS patients seems to be B12 injections which can be sufficient done subq rather than muscular. The dosage and administration should be at the minimum 1000 mcg injections sub-q every day for three days, then once per week for 4-5 weeks, and then monthly for life. Levels should be checked after treatment begins at 1 month, 3 months, 6 months and then yearly. HOWEVER, looking further, I found a more aggressive initial treatment seemingly more acceptable to those suffering from PA because they felt better faster and the body replinishes its stores faster. This treatment would be 1000 mcg dosage(s) injection sub q every day for one week / seven days, then twice a week for 4 - 6 weeks and then monthly for life. I ended up doing 1000 mcg injection sub-q for four days, then twice a week for 4 weeks and then once per week for 2 weeks and I'm now seeing how far I can get before I start to suffer from the tinlging extremeties. It was also helpful for me to "split" my dosage such as 500 mcg every other day (after the initial daily dosages) and then split 50/50 for the remainding weeks. After 7 weeks of my personalized treatment plan my B12 went up 425 points to 870. To me, it's amazing that my range was still under 1000 after all of treatment I received. However, it should be kept in mind that B12 is water soluable and there is no upper limit (a limit whereby the FDA warns to no go over). There are definite consequences to mega dosing even with water soluable vitamins that do not have an UL. I initially suffered from a particlar type of lesion (that looks remarkably like a pimple but isn't) on the face, neck, chest and back; however, it did subside when dosage decreased and compared to the pay off - it was a minor inconvience at best. It should also be noted that vitamin and iron levels should be considered by patient. The "normal range" is a highly broad range determined by a particular mean (group of patients/people). You and your doctor should work together to determine what is the best level for you! I also believe this regarding a whole host of other blood test(ing) and treatment(s). I also learned that high doses of Vitamin C can affect the number of the level of your B12 at a higher range -- meaning large doses of vitamin C can push the B12 reading/number higher than the patients true level ---- so that this should also be a mindful part of the treatment plan. My surgeon wants my B12 level over 1000 and I've just reached 870 so not too much farther to go!
This has become much longer than I anticipated so I will just STOP!
I hope this information is beneficial to you as well as others!
Update as of 07/12/2007: I haven't had blood work lately but have an appointment to recheck in late August. The longest I have gone since the inception of treatment without tingling is 21 days. Months later, I have not yet been able to reach the "once a month injection" goal. I suspect, however, that this is obtainable and in the near future. I have taken the prescription iron faithfully so I do expect to see *some* increase in my ferritin level (iron stores) which were exactly at the minimum on my last set of labwork. Because my B12 level were recovering and my H&H levels were good (and I have a conservative Hemotologist), iron fusions were not ordered. I am feeling better as well though may days are on and off -- good days and bad days and I never know which it will be!!!
*added from written post on 07/13/2007
**** I have the following information posted on my profile -- it was written after literally hours of research of medical journals, etc. and I have posted website for informative reading as well. For me, I believe that my B12 may have been on the *low* side for "me* prior to surgery which would explain some symptoms from which I suffered prior to WLS but couldn't seem to conquer. *I* believe it to be a shame that physicians don't look me for low B12 levels more often as raising B12 levels in many people who were even in the *normal range* yet suffering from *unexplained* physical, psychological, mental, and emotional symptoms have experienced dramatic life changes after raising B12 levels. *I* suspect that many people are improperly diagnoses because B12 is *overlooked.* Also, as a side note, typically anyone over 50 (irregardless of gastric bypass) begin to not produce less of the intrinsic factor (IF) in order to properly absorb B12. It is (in my opinion) of benefit for the over 50 patient to mindful of this medical *fact.* Low levels of B12 have now been linked to Alzheimer's disease -- though once the diagnosis of AD is made, it's too late to treat it with B12; therefore, it is *safe* to conclude by many studies that B12 should be evaluated and potentially supplemented by the over 50 age group.
http://www.nlm.nih.gov/medlineplus/ency/article/000569.htm
http://www.nhlbi.nih.gov/health/dci/Diseases/prnanmia/prnanm ia_what.html
http://www.umm.edu/blood/aneper.htm
If you go to google and run a search on "Pernicious anemia" you will find a world of information. As always, use the most reputable medical sites.
First, since you are post WLS, we KNOW without question or testing that you lack the ability to possess the intrinsic factor that allows the body to absorb B12. That part of your intestines has been completely bypassed so you will never again absorb B12 by food alone. Some are successful with the sublingual tablets. If you notice, the dosage is usually 2500 which is over 40,000 (fourty thousand) percent of the RDA. It is believed that some are able to to have success with this treatment because the dosage is so high that the body is *forced* to accept some of this component that is introduced into the body. The actual RDA of B12 is typically easily achieved through diet unless one has a disorder that prevents the body from producing the IF because of disease or as is the case when a portion of the bowel is bypasses as in the post-op gastric bypass patient.
Aside from the research I did on what causes PA, I also studied the treatment of PA along with lab tests, readings, studies, means, etc. My PCP didn't agree with the research I had regarding treating the anemia. It's important to remember that doctors (especially PCPs) cannot possibly keep up with all the current information on disease/illness/etc. and treatment. To do so, he'd never be able to see patients! Also, they are "general" doctors and not "specialists". The best treatment for any blood disorder will obviously come from a Hemotologist (though he can't know it all either! LOL) Anyway, my PCP wanted to take a much more conservative approach (injections once per month) which I believed would not help my stores quickly enough and it would therefore take me longer to recover and feel better. I had to "encourage" a better treatment plan than what he wanted but I got what I wanted and it has worked. The suggested treatments vary - some physicians think oral / sublingual B12 is sufficient and it may be for some but I felt like trying that hadn't worked for me. It does take 2 years for the liver to become depleted of its B12 stores which is why we start to see PA in WLS patients around the 2 year mark. The concensus regarding treatment of PA in post op WLS patients seems to be B12 injections which can be sufficient done subq rather than muscular. The dosage and administration should be at the minimum 1000 mcg injections sub-q every day for three days, then once per week for 4-5 weeks, and then monthly for life. Levels should be checked after treatment begins at 1 month, 3 months, 6 months and then yearly. HOWEVER, looking further, I found a more aggressive initial treatment seemingly more acceptable to those suffering from PA because they felt better faster and the body replinishes its stores faster. This treatment would be 1000 mcg dosage(s) injection sub q every day for one week / seven days, then twice a week for 4 - 6 weeks and then monthly for life. I ended up doing 1000 mcg injection sub-q for four days, then twice a week for 4 weeks and then once per week for 2 weeks and I'm now seeing how far I can get before I start to suffer from the tinlging extremeties. It was also helpful for me to "split" my dosage such as 500 mcg every other day (after the initial daily dosages) and then split 50/50 for the remainding weeks. After 7 weeks of my personalized treatment plan my B12 went up 425 points to 870. To me, it's amazing that my range was still under 1000 after all of treatment I received. However, it should be kept in mind that B12 is water soluable and there is no upper limit (a limit whereby the FDA warns to no go over). There are definite consequences to mega dosing even with water soluable vitamins that do not have an UL. I initially suffered from a particlar type of lesion (that looks remarkably like a pimple but isn't) on the face, neck, chest and back; however, it did subside when dosage decreased and compared to the pay off - it was a minor inconvience at best. It should also be noted that vitamin and iron levels should be considered by patient. The "normal range" is a highly broad range determined by a particular mean (group of patients/people). You and your doctor should work together to determine what is the best level for you! I also believe this regarding a whole host of other blood test(ing) and treatment(s). I also learned that high doses of Vitamin C can affect the number of the level of your B12 at a higher range -- meaning large doses of vitamin C can push the B12 reading/number higher than the patients true level ---- so that this should also be a mindful part of the treatment plan. My surgeon wants my B12 level over 1000 and I've just reached 870 so not too much farther to go!
This has become much longer than I anticipated so I will just STOP!
I hope this information is beneficial to you as well as others!
Update as of 07/12/2007: I haven't had blood work lately but have an appointment to recheck in late August. The longest I have gone since the inception of treatment without tingling is 21 days. Months later, I have not yet been able to reach the "once a month injection" goal. I suspect, however, that this is obtainable and in the near future. I have taken the prescription iron faithfully so I do expect to see *some* increase in my ferritin level (iron stores) which were exactly at the minimum on my last set of labwork. Because my B12 level were recovering and my H&H levels were good (and I have a conservative Hemotologist), iron fusions were not ordered. I am feeling better as well though may days are on and off -- good days and bad days and I never know which it will be!!!
*added from written post on 07/13/2007
**** I have the following information posted on my profile -- it was written after literally hours of research of medical journals, etc. and I have posted website for informative reading as well. For me, I believe that my B12 may have been on the *low* side for "me* prior to surgery which would explain some symptoms from which I suffered prior to WLS but couldn't seem to conquer. *I* believe it to be a shame that physicians don't look me for low B12 levels more often as raising B12 levels in many people who were even in the *normal range* yet suffering from *unexplained* physical, psychological, mental, and emotional symptoms have experienced dramatic life changes after raising B12 levels. *I* suspect that many people are improperly diagnoses because B12 is *overlooked.* Also, as a side note, typically anyone over 50 (irregardless of gastric bypass) begin to not produce less of the intrinsic factor (IF) in order to properly absorb B12. It is (in my opinion) of benefit for the over 50 patient to mindful of this medical *fact.* Low levels of B12 have now been linked to Alzheimer's disease -- though once the diagnosis of AD is made, it's too late to treat it with B12; therefore, it is *safe* to conclude by many studies that B12 should be evaluated and potentially supplemented by the over 50 age group.
I have two sides to my brain - a right side and a left side. The trouble is sometimes there is nothing left in the right side and nothing right in the left side.
Post-Op RNY 6.5 years
HW 252 GW 140 CW 140
Topic: RE: Post-RNY_Eating_Disorders
Hello Jamie,
Thank you for your response to my email. I need all the support that is available to me. Right now I'm experiencing a great deal of fear and resentment. These feelings are a definite trigger for me to go to inappropriiate comfort foods. It is not often that I choose the comfort foods, nor do I eat the quantities I used to before surgery. I know the only answer for me is to turn to my support groups and my HIGHER POWER when these feelings come up.
My husband is a person with definite food issues and he is developing food related diseases. He refuses to acknowledge that food is his problem. My father passed away last October from his food related diseases after a 20 year struggle. I was my dad's caretaker after my mother passed in 2004. My fear is that my husband will walk the same painful road as my dad. I need to be loving and gentle with him as this is a disease. I don't want to show resentment . I need to work my 12 step program and be there for him no matter what.
I am angry because after spending $25,000 out of pocket for my RNY, I have developed potential debillitating back problems which sorely hamper my exercise program. Thank you G-d, none of my problems are terminal, but very exasperating. Through this support group, I hope I can help someone else through sharing and get outside of my own problems.
Thank you for letting me share.
Carol
Topic: RE: Post-RNY_Eating_Disorders
Carol: Thank you for sharing your strength hope and support! I agree things like OA, CODA, ALANON all can augment our journey if appropriate. I wish you continued success!
Jamie
Jamie
Take Care, 
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!"
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!"
Topic: Low insullin levels
When I called my Dr's office today of course he was not in but his nurse said my insullin was low ...I am so clueless ...my other labs were great...I was Type 2 insullin resistant post op..how can I fix this ?? I am at goal 243 start 118 today...please advise Lisa
Topic: RE: Post-RNY_Eating_Disorders
I wish you well, I agree obesity is not a character flaw but a multifactorial disease which necessitates multifactorial therapies, none of which are perfect.
For myself recovery can be defined as a personal journey requiring hope, a secure base, supportive relationships, empowerment, social inclusion, coping skills, and finding meaning. The goal of treatment being wellness---a return to a life that is meaningful. Recovery happens when illness stops getting in the way of life.
Along life's path, recovery can be sustained fully but it is also possible for recurrance of previous illness or symptoms. Life is challenging; for me this is not bad rather just is (acceptance for me) and opportunities and lessons to work on is all. Denial for me is a dangerous part of my addiction, such as dneial in the belifs that I am totally cured of my obesity, my food addiction or my codependency issues. When I believe I am cured I stoo beeing aware.
I think it is great you are in therapy! (wow 3x week!) Surgery was the easy part looking back although going through it I thought it was the hard part (ha how skewed that was!) living the lifestyle after in a consistent, self responsible manner is the most CHALLENGING thing I have ever chosen to do, I did not realize preop the immense effort it takes each moment to be healthy! It is so worth that energy though the freedom it brings!
The enormity of the decision to have WLS is difficult at best to grasp, and morphs and changes as time progresses postop from the 'glorious' honeymoon to years 2, 3, 5 and beyond. The psychological piece is larger than many realize going into this so you are one step up! Those emotions such as fear, shame, guilt anger etc can pop up and w/o food sometimes we slip back into old habits....
For myself recovery can be defined as a personal journey requiring hope, a secure base, supportive relationships, empowerment, social inclusion, coping skills, and finding meaning. The goal of treatment being wellness---a return to a life that is meaningful. Recovery happens when illness stops getting in the way of life.
Along life's path, recovery can be sustained fully but it is also possible for recurrance of previous illness or symptoms. Life is challenging; for me this is not bad rather just is (acceptance for me) and opportunities and lessons to work on is all. Denial for me is a dangerous part of my addiction, such as dneial in the belifs that I am totally cured of my obesity, my food addiction or my codependency issues. When I believe I am cured I stoo beeing aware.
I think it is great you are in therapy! (wow 3x week!) Surgery was the easy part looking back although going through it I thought it was the hard part (ha how skewed that was!) living the lifestyle after in a consistent, self responsible manner is the most CHALLENGING thing I have ever chosen to do, I did not realize preop the immense effort it takes each moment to be healthy! It is so worth that energy though the freedom it brings!
The enormity of the decision to have WLS is difficult at best to grasp, and morphs and changes as time progresses postop from the 'glorious' honeymoon to years 2, 3, 5 and beyond. The psychological piece is larger than many realize going into this so you are one step up! Those emotions such as fear, shame, guilt anger etc can pop up and w/o food sometimes we slip back into old habits....
Take Care,
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!"
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!"
StarvingArtist
on 6/18/08 12:53 am - In my Studio
on 6/18/08 12:53 am - In my Studio
Topic: RE: Post-RNY_Eating_Disorders
Thank you. I will do that if it triggers some old feelings. I feel very solid in my recovery, and for me it really doesn't feel like a life-long challenge. I have filled my life with things that matter to me. My weight is merely a health issue now, not a character flaw and not a way for me to escape. I know some people do struggle some degree of ED's throughout their lives, but I do believe full recovery is possible. But, on the other hand, I'm obese...so perhaps my obesity is just another form of the ED and the anorexia/bulimia will awaken when I no longer have obesity to hide behind.
I'm in therapy 3 times a week now to try to deal with any upcoming issues as soon as they happen. :)
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