You have RNY, you lose weight, you feel great...BUT MONITOR YOUR BLOODWORK!!!

Let me preface this preachy post by saying I am asking you to do what I am advising, and not what I did. Because what I did was stupid.

I had RNY in December 2013. 4 years and 4 months ago. I was the poster child for WLS that first year. I listened to the vets on this site and ate high protein, low carb, never drank with meals or for at least 30 minutes after, abstained from alcohol, and worked out daily and didn't eat back my calories. Basically, I just attacked WLS like it was my job. That led me from a surgery weight of 351 lbs to hitting my goal of 160 lbs in one week short of one year.

That year was magnificent! My pouch was small, my resolve was strong, the compliments were fast and furious, my energy was off the charts! My knees no longer ached! I could wrap the gym towel around my body! I had so much extra space in the airplane seat! I was living life!

And I was decently compliant with vitamins. I took them on weekdays, mostly remembered on the weekends, and since I had lost weight and was maintaining the loss and felt good, I thought I was good. When I heard about PatchMD vitamins, I was like, "Yes! Vitamins for lazy people who forget to take pills like me!". For the last year, I started pasting a vitamin patch on my thigh everyday - one multi, one calcium and one iron.

My surgeon's office has crap aftercare, so I hadn't seen him since 6 months post-op. When they called me for my four year follow-up, I decided why not. I went in and gave all the vials of blood. They called me back in to discuss my labs, and gave me horrendous advice. They told me my ferritin of 6 was fine. They told me I could eat Tums (calcium carbonate) instead of calcium citrate and would be fine.

Well, as you may have read on this site, you are the only person who can advocate for you. I decided to finally take my bloodwork seriously and started charting my levels on this incredible spreadsheet that Julie Sparklekitty posted a while back. It shows you the things that should be tested, what the normal levels are, and what a WLS patient optimal level is.

It turns out, I have a variety of deficiencies. My ALT is low, which indicates a potential problem with my liver. My iron was 53, and while "normal" is 49-167, ideal for us us 80-100. Normal ferritin is 30-400, and mine was 6. That's a SIX, y'all. B12 should be 246-911 and mine was 234. Low. Vitamin D should be 15-75, and mine is 19. Also low.

This has led to me having to change my vitamin regimen to chewable Bariatric Advantage Multi-EA, chewable Bariatric Advantage calcium citrate, a sublingual B12, and a vitamin D. I've had multiple appointments with my PCP and a hematologist that she referred me to. Yesterday I had my first of two iron infusions. I'm scared to see what my insurance will cover, as this whole process has already set me back almost $1000 between bloodwork and co-pays.

So when I say do what I say, not what I did, I am referring to being compliant with your vitamins and getting regular bloodwork and monitoring it. Reaching my goal weight and living my best life will be short-lived if my body isn't getting the nutrients and vitamins it needs. Please please please take your vitamins, get yearly labs, and track them somewhere to notice changes over time. This is not something to mess around with. Being hooked up to a bag of liquid iron, spending hundreds or thousands of dollars, trying to get my levels to something near normal, could have potentially been avoided had I realized it was a problem early on.

I was (still am) taking iron faithfully when my numbers plummeted around year 6. I was able to raise mine using Proferrin so I did not have to get an infusion.

We must stay diligent for life!! Labwork and tracking our own results are a must. No one cares as much about our health as we do. Doctors are busy and do not always catch trends.

I plan to be an active senior citizen and won't be able to do that if I don't take care of myself.

Great advice.

I decided to take the patches for iron and calcium for awhile. I was not absorbing iron, so I figured it could do no harm. And the calcium was just because I had been getting a little lazy on all the doses, so I thought I'd help myself out.

Turns out, I am one that can not use the patches. My calcium levels, which were fine before, plummeted.

My advice for patch users: make sure you do not go too long without having your levels tested. While many do great on them, don't assume you will be one of those. I have always monitored and tracked my levels and I'm not ignorant as to what my trends are or should be. However, my ignorance in regards to patches set me back and I'm still trying to bring my levels up. Grrr...

When I asked my surgeon (who I still see every 6 months even though I'm almost 4 years post surgery) if I could switch to the patch, he said yes, but only if I had labs drawn right before and 5-6 months after regular use. He knew that I was vigilant with my supplements and figured he'd be able to notice any drops quickly. I absorb the multi and the calcium, but don't absorb the iron at all. My ferritin dropped from the 200s to the mid to low 100s in that short period of time. I no longer use the iron patch and am seriously considering switching everything back to pills. If you absorb them, they're great, but you definitely have to be vigilant.

One more suggestion, and please someone with more experience correct me if I'm wrong, you can't tell calcium levels from a blood test. If you're deficient in calcium, your body will pull it from any available source, i.e., your bones. So even if your blood test comes back in an acceptable range, you might be deficient. My surgeon sent me for a bone scan, even though my calcium came back ok, because he noticed a dip in my levels. Wouldn't you know, the test came back showing that I have osteopenia, the beginning stages of osteoporosis. It was very concerning to him (and me) given my age and the fact that I actually keep up with my supplements. My story just goes to show tha****ching your labs is vital, knowing what the levels mean is just as important and if you don't have someone advocating for you, you need to do it yourself. Take your supplements, have labs drawn and watch and understand your levels as if you life depends on it . . . because it does.

I've done a 24hr urine collection test for calcium. You're right in that a blood test won't tell because your body will pull calcium from wherever it can get it and your blood will always test fine.

Jen

I did the 24-hour urine test too. Thinking back, I think there was concern with my PTH levels and that led to the urine test which led to the bone scan. I'm now scheduled for yearly bone scans to make sure I don't progress into full blown osteoporosis

It was my PTH levels that threw my PCP into a tizzy. She had no idea why they had changed so much and wanted to send me to an endocrinologist. I knew why...stupid patches. I asked her to give me a few months and then recheck, which was further indication the patches hadn't worked, as the retest numbers were closer to range. I get tested again next month and I expect everything will be normal again, as I've been pretty diligent about my vits.

My PTH values were causing concern before I switched to the patches. My surgeon's office was so concerned that they sent me to an endo to confirm/determine if there was an issue.

Are you taking Vit K2? and magnesium? We need Vit D3 to be in 50-75 (optimum IMO), plus we need to add magnesium to our supplements (citrate and glycinate - is best absorbed, oxide is best for BM), plus K2. i use K2 MK-4 and MK-7 in dry form , app 100 mcgr or 200 mcgr of each - away from any fat.

D3 helps us absorb calcium, the K2 directs the calcium to our bones. I am not sure if there is a reliable test for K2 levels. But if your body absorb calcium- but can't put them into your bones - it may cause calcium deposits into organs, or blood vesicles. Or cause calcium-based stones.

K2 and magnesium is as important if not more important as D3 and calcium. Low carb diet may cause magnesium depletion unless is supplement. Most studies recommend 2:1 calcium to magnesium supplementation, but some suggest that 1:1 is more appropriate.