PCOS + Issues

I am crossposting this since I haven't gotten a response elsewhere and just found this PCOS forum.  I would be grateful for any response or help - I feel really alone on this. So, I posted a while back about never reaching my goal since my RNY in 2003.  Then I started gaining and have regained about 30 pounds total.  Through a lot of doctor visits / lab runs we found I was so anemic that my body was making fewer and smaller red cells.  I'm currently getting IV iron treatments because I malabsorb most pills (unless sublingual or chewable).   My upper GI shows a small pounch but a stretched stoma.  I take full blame for that, after I plateaued I gave up and figured I'd failed.  Plus I was always tired anyway.  The tiredness was from depleting my iron stores due to malabsorption (I had no idea) and the failure was all in my head - I should have gone back to Dr. Halmi for help, but didn't.

You can't imagine the complications now.  I don't know if I'll ever be eligible for a revision due to my iron issues, but I do know that if things stay as they are now, I'm destined to regian the other 75 pounds I had lost and more.  I would say I'm depressed but it's an understatement.  My new OB/GYN is a thyroid specialist and mentioned that in her testing she thinks I have a genetic metabolic condition where my body basically ignores the insulin in my blood.  (She's much better with the medical lingo) Then she told me I have PCOS as well, it was NOT a good day at the doctor's office.  Basically, she wants to put me on something called Metformin? that has shown results with people having the condition and they lose weight naturally because their body processes things as it should.  She wonders if I could have avoided having a RNY (and possibly the malabsorption issues) if that had been discovered four years ago.  However, since everything I eat goes straight into my intestines and is not digested properly, she won't prescribe the metformin as it only comes in pill form.

Suffice to say, I'm frustrated and terrified of going back to my previous weight.  I don't know what to do.  My clothes are too tight, I'm still too tired to go to the gym (I barely have the energy to go to work and walk the dog) due to the anemia and frankly, I feel completely defeated.  How is this happening when I'm only 32?

I'm sure this is not a common situation but if anyone has any advice or a similar story, I could use the encouraging words or ideas of what to do next.  Right now I'm just getting the iron fixed, which I'm happy about, but I'm still gaining weight incrementally.  I'm told the severe sugar cravings  are part of the side affects of the severe anemia and that won't probably change for about four months, once my body is producing new healthy cells that aren't craving whatever they can get to replace the missing iron.  Sugar is bad.  For me, it's like kryptonite - so what do I do?

I'm possibly not posting this in the right place but I'm at wit's end.  Help?

Hi there!  I'm glad you found this forum and and I'm glad you're getting your iron issues worked on.  I know a lady on the post op prego board who had lapband after RNY due to a stretched stoma.  Now...she doesn't have PCOS but was able to get her weight gain under control with that aid.  Also, on another website I visit ( www.soulcysters.com ) there is a WLS Divas thread for us cysters who've had some sort of gastric surgery (lapband, RNY, DS & VSG) located on the Diet & Exercise forum.  Anyway...there are 2 ladies on there who do still take metformin.  It sounds like your insulin resistance is either resurfacing or never completely went away.  My friend on there Leigha...doesn't really loose any weight (with the RNY) unless she's taking Metformin.  While it's quite possible that had you discovered the PCOS & IR (insulin resistance) prior to surgery it's not guaranteed that Metformin would have allowed you to loose weight without surgery.  I was on Metformin for 5 years before I had surgery...it did not help my insulin resistance as I later became type II diabetic...and it did not help me loose weight.  However for many cysters it does help greatly!  I say give the Metformin a try.  You can expect some gastro-intestinal upset if you start out at a high dose...especially with a high carb diet...but if you start low...at 500mg daily...and then build up to what your doc wants you at the intestinal discomfort should be less.  The most issues I had from it were some abdominal cramping & diarrhea...typically after I ate a high carb meal.  My belly liked me more when I ate low carb. If for some reason the metformin isn't working (give it some time to work though)...maybe look into a lapband revision so they can band your stoma site. You can still loose the weight...don't give up! Oh...for sugar ideas...what kinds of sugar are you eating?  If it's cookies & such...try making cookies with splenda...so you get the sweetness but not the sugar?  Just a thought.  Good luck!!  And of course...I'd be happy to help any more if I can.  (BTW - check out www.soulcysters.com it is an awesome support/information website for women with PCOS). Kristy

I have both pco and a difficult time with keeping my blood count up, my endo said that I could start on drugs that would maybe help me to loose 40 pounds but what i really needed was WLS and he was kind but blunt about how I need to do something fast or my life was going to be very short. he was the 4th physician in 2 months to reccomend the same solution, and they all know i am anemic half the time.  do the best you can with what you have now regrets solve nothing and only lead to deeper depression.  Also try to be patient but firm and keep asking questions and seeking help from the doctors some of the time i just want to crawl in a hole and just die but when i dont die immediatly i start trying to figure out something else to do LOL... Ive almost hemoraged to death twice the 2nd time they toasted my uterus so that hopefully it wont happen again but they couldnt remove it cause im to fat!  So i totally hear you on the anemia thing...

I also have PCOS & Insulin Resistance, diagnosed a few years before my WLS. I was initially put on Metformin and it didn't help anything, although I know it has helped others with their weight loss, blood sugar levels, fertility and avoiding diabetes. Unfortunately, no one pill works for everyone and there are too many unknown factors that determine whether it would work for you. Metformin pills are time-released, so taking them after a gastric bypass reduces their effectiveness, however, taking them at night and adjusting the dosage may work. However, with that said, I think you need to get your doctor focused on your THYROID before you worry about the IR. I have been diagnosed with hypothyroidism (low thyroid hormone) after my WLS and they suspect (as I always did) that it was there before the surgery regardless of my normal test results. You can have reduced ability to utilize thyroid hormone at the cellular level even though you have enough in your blood to make the tests come back OK - it's similar to IR, you have enough, but your body isn't using it right. The anemia is probably causing a lot of your fatigue, but chronic fatigue and chronic unexplained weight gain are two very common indicators of hypothyroidism. Ask your doctor if she would be willing to start you a trial of low-dose thyroid medication, preferably one that contains both T3 and T4 (like Armour Thyroid 30mg or 60mg). Most people start to notice their symptom reducing in days after beginning treatment, and the pill is not time-release so you should be ok taking it with your bypass. If the issue really is your thyroid, you will find losing weight easier and you will have more energy. With the reduction in weight, your PCOS and IR complications will most likely be drastically reduced or eliminated and you won't need to take additional medication. You may also not need to have any revision done to your enlarged stoma. If you do require a revision surgery, your insurance should cover it since it is considered a defect in the original surgery -- you can either have it surgically revised laparoscopically, or have it banded. They are currently testing a new procedure where they can tighten the stoma endoscopically (through a tube down your throat), but I'm not sure if this procedure is widely available at this point. For now, focus on fixing your iron, discuss thyroid therapy with your doc, and get back to healthy eating (calories, content and portions!!). I'm sure things will begin to get better if you take back some control. I know it's frustrating and demoralizing, but you can do it!!!! ((((HUGS)))) Edit: P.S. try eating some cheese when you get the sugar cravings, or even a small portion of fruit.... but don't put sugar or high (white) carbs in your body!!

Just to ease your mind... I took metformin before any weight loss surgery and never lost any weight with it... it just made me feel bad all of the time... so I am sure your WLS was a good thing and you just need to go back to the basics and see if that helps. Good luck!

First let me say, thanks for the encouraging words.  Since I posted originally, a few things have happened. First, on the anemia front, I completed 10 weeks of iron IV treatment and that seems to have done amazing things for me.  I will likely need booster shots every couple months (I'll find out for sure tomorrow), but otherwise, I feel so much better. Second, on the revision front, Dr. Halmi agrees that a revision is the best option for me but wants to use the stomaphyx procedure since my pouch doesn't appear to be stretched much if at all and it's mainly the stoma that needs tightening.  He also wants to move the attachment to my intestines lower, I think laproscopically.  He seemed very optimistic and is contacting my insurance company for me, I should know about that within a week. So, that's all good news right. Plus the fact that I've been eating better... well until the last week or so.  I could figure it out, why such carb / sugar cravings when they had basically gone away.  I've been pounding back the protein and water, really watching my food intake.  Then I noticed that despite taking the pill (YAZ) without the break for a period (doctor's orders), I'm still getting a "period" every month for about a week.  Complete with bloating and weird cravings.  Hence the sugar rush mentioned above... This morning, however, was the final straw.  I was brushing my hair to get ready for church when it started coming out in huge clumps.  I have to bald spots on my head.  I've worked so hard to get my hair healthy and long again, so I did not react well to this.  I don't think there are any tears left in my at this point.   Suffice to say, either my malabsorption problem is affecting other areas or the increased weird hairs on my chin, rapidly growing eyebrows, continued periods and now hair loss means my PCOS is NOT getting better. The thought of losing my ovaries before I have the chance to have a family truly slays me.  I keep trying to pray, but I can't find the words.   I know you guys can't do anything, but it helps to be able to tell someone how helpless and hopeless I feel.  Everytime good things start to happen, something really bad crushes me.  Why is that?