malabsorbtion problems

lacastillo
on 8/4/08 10:50 am - CA
Hi.
I was discussing my upcoming RNY surgery with a BC nurse and she told me that RNY patients have to be very careful about checking if we are not absorbing the vitamins we are supposed to take after our surgery. She also told me that I'd better be careful because I am taking warfarin to thin my blood since I suffered a stroke in 2003 from A-Fib. She siad my body would not absorb the warfarin and my blood might not be thinned enough. This really freaked me out. Then she told me that I had to be careful w/Vit A , since I had to stay away from "the upper limits" on the vit, becuase that would also affect my INR levels. I just want to MAKE SURE that if I take my Vits as directed by my bariatric surgeon & my calcium, that It's gonna be OK with this surgery. Otherwise, it's a lap band for me- Thanks - Lindy
Pam T.
on 8/5/08 12:31 am - Saginaw, MI
Lindy -

Yes, you'll have malabsorption issues after RNY -- that's the point, rigth?  But that's also why we have to be so diligent with taking our supplements according to our surgeon's direction AND following up regularly with our lab work.  During the first year after surgery you will probably have your blood drawn every 3 months to make sure you're on track with your vitamins.  After that it is going to be every 6 months or 1 year for the rest of your life. 

And it's not just RNY.  New studies are showing that even Lap-Band patients are having issues with vitamin deficiencies due to the decreased levels of food they are eating, thus the decreased levels of nutrition their bodies are taking in.  So even if you go with the lap-band, you'll still be on supplements for the rest of your life and might be facing the same type of deficiences as anyone else. 

Yes, some medication you take now might need to be adjusted after surgery.  Your doctor will need to switch you from time-released forumulas to ones that act more immediately in our bodies.  Some medications we'll need to stay away from due to the added risk of ulcers and damage to our pouches (NSAIDs, for example).  This is something you'll discuss in depth with  your PCP and surgeon - they will work with you and your current medications to find a new balance that works for you. I'm not familiar with warfarin, so I can't advise on that ...  Nobody here on a message board can, really, it's best to let your team of doctors make those decisions.

And yes, there are Upper Limits to the vitamins we take.  That appies to ANY person, not just WLS folks.  You can learn more about the Upper Limits for whatever nutrient you are interested in at this great website.  Worlds Healthiest Foods.  Just do a search for Vitamin A, the scroll down in the results to the section about that nutrient (all the foods that containing Vitamin A will be listed first) and read everything you'd ever want to know about that Vitamin.  How much you should take, what the deficiency symptoms are, what the toxic effects are if you take too much, which foods contain it, etc.  It's a great website for in depth information.  But remember that the Upper Limits is for normal people with a normal digestive system, so your surgeon might recommend taking more of certain things because of the malabsorption of the surgery.

A couple articles that you should read regarding lifetime supplement needs and how the body handles medication after surgery. 

Bariatric Nutrition - from ASBMS
Medication and Nutrition Considerations - from American Journal of Health System Pharm

I believe that the key to success after WLS is knowledge.  Knowlege is power.  The more you know about your body, it's digestive system and how it works after you rearrange things... the more successful you will be in treating yourself right and maintaining lifelong health.

HTH
Pam



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The scale can measure the weight of my body but never my worth as a woman. ~Lysa TerKeurst author of Made to Crave

 

amber T.
on 8/8/08 8:11 am - somewhere, KS
Hey, I 'm also a nurse, and vitamin K effects your INR, not vitamin A. As long as your surgeon is aware that you take coumadin, then they will manage it. If your INR gets to low (your blood gets thicker) they just might have to increase your coumadin. Anticoagulation is a patient by patient guessing game, add a little, take a little away...et****il you get that INR within therapeutic range. Good luck, and just make sure your doctors are on board about what meds you take, they just might increase the time in between having your INR checked.
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