deficiencies??

Hello my friends,I post here sometimes ,but I live on this board.I love it, you guys are a wealth of knowledge and I commend you for being so open and honest with us.

I know you are probably tired of us newbies coming on here saying that we are scard.I think for me anyway it is a way to relieve stress or just talk  .like I am about to do..  lol..

I am hoping to have RNY as soon as my diet is complete, I am sooo excited about it.I am constantly reading or researching it,that being said I have been on a lot of boards here and hearing about so many complications and deficiencies.I know everyone is diffrent and all that but does most complications stem from not taking vitamins and checking labs when supposed to?I will be on top of that believe me, but why would someone not? is that a silly question?I have 2 beautiful small children and I would not do anything to jepardize my health that I could control.
Anyway that is the reason I am wanting this surgery, I want to be around for my kids for a long time and actually be involved ,not just set back and watch.
I guess I am just needing some positive feedback. I know there are alot of you out there.I guess I am focusing on negetive ones. I am trying to learn as much as I can so I can be healthy.My aunt was telling me about 3 people she knows had RNY and two of them can't seem to get out of the hospital.I am afraid I will be one of the unfortunate ones.How are you guys doing?Thanks for letting me talk.I would appreciate any feedback goo or bad. Again sorry for the repetative questions.

rcernadas

You just keep coming back here asking as many questions as possible. That's what preops are supposed to do.  Yes, deficiences can be a big problem after surgery. But if you know what the symptoms are, what vitamins to take, and have a supportive pcp to help you - you should be just fine.  Personally, I've had a couple of life threatening things happen since wls. They were all caused by deficiency in one way or another. But mostly they could have been fixed way sooner had I had a doctor who was looking out for my best interest and not his own image.  You can be deficient in vitamins an nutrients without your labs coming back in the "low" catagory. Our post op bodies do not absorb normally anymore. For me, I found out (the hard way) that my body was not absorbing anything from my vitamins. I started having major symptoms but my surgeon ignored them, told me they weren't wls related, and that it was all in my head; because my labs were still in the "normal" range even though it was the low end.  My advice is quite simple and really makes a lot of sense. Take charge of your own health care!!! No one cares about you more then YOU! Now I know where my labs have to be (through trial and error) and I would never ever let a doctor tell me otherwise!!!!!  I'm 2.5 years out now. Living an awesome life!!!! I've got NO health issues at all and I'm enjoying all the benefits of being healthy!!  You can't base your success/failure on someone elses; because we're all just too different. Some will have major issues (like the two people you mentioned) MOST will sore through just fine with no issues at all. It's up to you to decide if its worth the risk.  Best of wishes to you!!!!!!!!!!!!!

Thank you so much for your information,it was very frank and I appreciate it.I know I have to do this,but you can bet I will take charge of my own well being.Thanks soooo much again.You are very sweet.By the way...You have done awsome and look GREAT!!!

RCERNADAS

Just reiterating what was said. When part of your stomach (ability to DIGEST) is disabled AND part of your intestine is bypassed (means: food doesn't go there any more), there WILL be predictable, preventable deficiencies. The problem is that "programs" are bought and sold, whether they are good or bad. When I first started attending ASBS conferences, several MD-RD combos had come up with programs that were packaged and sold (how to eat, which vites to take, etc...not the actual vites). Doing what I do, seeing what i see, I was APPALLED at the misinformation being given/sold/exchanged as helpful for us when it was SO NOT!

But these are not the ppl who live in our bodies. I always get a laugh out of advice from medical professionals about how pouches work and feel, when we all know much better that they do not live with a pouch and it does NOT feel like that. We need some guidelines, at first, of course, but we need to grab the reins and be in step with every facet of our care.

One of the marketing tools for the lap rny is that it is not malabsorptive. ??? So, with 90-95% of your stomach, lying around with nothing to do, never sees food again, how, exactly do we DIGEST ANYTHING? And since every nutrient that we need has a specifically assigned place in the intestinal tract to be absorbed, and various chunks of said tract are now out of the loop, so not exposed to any food, digested or undigested, how can it NOT be malabsorptive?

I pay close attention to what programs which clinics are pushing, because I know exactly which deficiencies to expect. My first question to someone is usually, "Who's your doc?" because that also tells me your program, and maybe his belief system, so to speak. One sugeon is so ful of himself that even if we can get PCP's to order the right tests, if they confirm with him, he will tell them NOT to run the fat solubles, because HIS surgery is not malabsorptive. I've even discussed this with him over lunch and cannot make him see that body parts that are not in use MAKE A DIFFERENCE! LOL

So, yes, you have it right. You need to be taking all the right vites, in the right forms, and enough units to make up for what you cannot get from food any more. You need to be tested regularly, FOR LIFE, and you need to chart those results yourself. As time goes on, you'll be glad you did, because most docs (just not surgeons, so much) are happy to look at a spread sheet vs 5 yrs of labs!

You will know that your iron levels are trending downward BEFORE you feel sick. You will know that your vit D levels are dropping long before you have bone or dental issues. And you may have to stay within the long term WLS world to get your answers, because many surgeons do not have them, nor do PCP's.

And it's not because they are stupid or weren't paying attention that day. This stuff just isn't really written in any textbooks in school. THere are journals in this field, of course, but if you are a surgeon and you get 20 "papers" a day to read, and 15 are surgical techniques or tools, 3 are insurance, 1 is legal and one is vitamins......... which are you going to eliminate? See?

I want my surgeon to keep up on the latest rx drugs, and I'll take care of the OTC stuff. He can keep up on the latest tools and techniques, and I'll just make sure one of his tools for me is labs every 6 months.

Michelle....great info as always!!!!!   Isn't it amazing how little some surgeons know about the procedures they are doing?   I try to keep up on the latest "testings"  for DSers because I will normally hear about the new stuff here, before I hear about it from my surgeons office (the wealth of knowledge on these forums is amazing...it's like getting 100s of medical doctors to give you advice ...even though it's 3rd party). Scott

I see "the orphans". The ones whose docs have moved or retired or do not do long term follow up or don't run labs. I see the DS who had single digit vit D levels and I suggested putting them up where they belong and she did. She felt human again.

She started seeing another doc who told her that she was taking too much vit D!! Stop it at once! Did not look at her labs, only her intake. She felt AWFUL after only a week with no vit D.

So many simply do not understand that for a DS, 50,000 units is NOTHING. A speck. For me, as a 100cm common channel distal, had I been starting from scratch, 50k would be nothing for me, also. Since I've had years and years to play with my levels, I can fairly well manipulate them, but I can't go by normie rules! I read mountains of stuff on vit D every week, then adjust it to fit a person whose innards are no longer available! LOL

And since this is all I do, every day, I KNOW that any doc whose practice extends beyond vites simply cannot keep up with every subtle nuance of the nutrition world.

And then there's US. LOL

I have talked to several of the DS surgeons (takes serious guts to do those!) and I could prolly argue about vit D (and then A & E, in that order) til the cows come home, and they cannot get beyond ADEK's for starters. Why wait til you are sick or have lost bone/teeth? Why not PREVENT all that?

OK, never mind. Can you tell I had a very rough vit D day here in my world? LOL

We start them on 50K a day of dry form D3. I think 50k a day of dry A, retinol, and 800 units of dry D, as in d-alpha.

Tanning delivers UVA, which does not convert to D3. UVB is UV-"better") and that's sun light, but for us, it doesn't seem to convert and if we're up north, WHAT SUN? And even if we COULD get sun, it's worth maybe 5 pts, over all, not the 50 most ppl need to get into optimal zones.

If you email me privately, I can send you our DS starter list, and then the "fixit" when i get orphans. My doc starts them on 100K of D!! Imagine!

The Drisdol is D2, in oil. So, again, it may raise levels a few points, but if you're serious about hanging onto teeth 'n bones (remember, it's too late for my bones, hence my rabid approach!), then dry D in D3 form is the best way to make sure your dollars get into your bones, you know? The body only reads D3. So, while you can sit down in FL on the beach and eat oily fish and egg yolks all day long, if you want to get and hold ideal levels, take enough D3 to hold levels of 70 or do, based on recent range of 32-100.

OK, on frequency. I've heard this concept of taking a corrective dose "for awhile", some test, some just assume it is fixed. That makes zero sense to me. We (us shorty common channels especially) cannot get vit D from dietary or sun sources in any reliable fashion. So, once deficient, always deficient.

Cars are my fave analogy, so let us say my tires are worn. I use the car all the time, so even if I get new tires, get them checked, rotated, etc. per mfr specs, they still wear out. That's the nature of them. I've got the Cadillac of surgeries (available way back when), so I need to keep my specs up a bit more. Much like my run-flat tires (not my choice), they only last 40k miles, but on the other hand, my method of dealing with a "flat" is a little light on my dash that lets me drive to a safe fixit place. I don't have to get out on the freeway to deal with an emergency.

OK, so I have the most malabsorptive procedure, along with BPD and DS ppl, so we have to be more hawk-eyed. Our "wear" will be faster and more abrupt, so we need to tweak more often. Our "cost" (units to take) to fix the wear down is more substantial, but then, in many ways we're "safer", since our regain is minimized and with all this fuss over labs and supplementation, we often end up in better health than less radical procedure ppl.

Did that make sense, or only to me? Because we/you have the most malabsorptive procedures, we will ALWAYS be running short in A, D, E, iron, calcium. But we know this up front, so we supplement the daylights out of it, test, adjust, test, adjust... FOR LIFE.

When I suggest 100k a day, it is with the proviso to test again in 30-60 days and see if the levels are shooting up or crawling up or WHAT? Then adjust to smooth out the levels and then HoooooooooooooooooooLD perfection when you find it. Because we can't just change these levels in 24 hrs, it takes years to get it right for each person. While i JUST changed us from 30K a day of D plus 50K twice/week, I got a level of 98 (top is 100), my dh has had 63-64 for a year now. Well, good enough, so I gave him the left over 5's and also 50k a day, so for him, a total of 55k a day. Labs in April will tell if this was right or not. STILL, he has forfeited his teeth, so we can't be too careful

So, my email is [email protected] and I have all kinds of stuff canned, but the PM and stuff seems bulky for this old person to use. LOL.

Funny we should meet here at almost the same second. Thank you. I hope there will be a generation of DS that do not have to GET sick to get well first, you know?

Of course, I'm still waiting for that generation of RNY's......

I got to thinking that I mighta mistated something. Sometimes I get so wrapped up inside my head knowing what I mean that I do not convey it clearly. Unfortunately, sometimes fixing it makes it worse, but here's my attempt.

I said, once deficient, always deficient. Well, yes and no. What I mean is that if you went into deficiency once based on traditional input (dietary, sun, eating carrots or raisins or whatever someone tells you to do to get the vites we need), we will ALWAYS have the need to supplement. Obviously, once we fix it, we do not have to REMAIN deficient, but can remain in remission from deficiency as long as we address it correctly (again, difference person to person).

If we were deficient based on the "usual" sources of that element, we will remain or return to that deficiency even if we fix it once.

OK, did I make it better or worse? LOL