Something new from UCLA

I've been dealing with rashes on my body since about a month after surgery and got nowhere with the dermatologist that I was sent to. They did a biopsy and it came back eczema (which is basically a shoulder shrug). I've done a bit of ****hing and found at webmd Atopic Dermatitis (this is on the label of the cream they gave me so it was a start). It said soap, laundry detergent, food and stress. I ruled out soap, ruled out laundry detergent and basically foods (including splenda and equal) by changing all of that one thing at a time until I couldn't rule out stress. So I was thinking stress and THAT stressed me out.  The cream they gave me just didn't touch it at all. Now it's spread and moved to different parts of the body. Right arm from the wrist to the elbow; left arm just at the elbow; left shoulder in front of the armpit; at the waist above the waist band in a nice circle; on my right shin, moved from the left shin but gone on the left one now...It moves. Oh, and on the back of my left hand. Itches like CRAZY. And it looks really bad so I try and keep it covered cuz it's pretty scary looking. Suffice it to say that I went to my allergist today and he looked at it and said he would do some checking with UCLA on line and came back to me (he checked RIGHT THEN) and said that they say that a rash like what I have is possibly a side effect of WLS and caused by a deficiency. He also said that it's quite common and what else is quite common? Arthritis. They're thinking it's an autoimmune deficiency that causes it, not a vitamin deficiency but that's also what he's checking into. He gave me something to take with breakfast for the next five days and I'll go back on Monday. I believe I'm taking a steroid in pill form.  Anyone have anything like this or thoughts on what I can ask them to look into? I see my PCP doctor next Thursday and the original dermatologist (the shoulder shrug guy) on the 25th. I had a blood test that was pretty comprehensive (recommended by my surgeon) in July (1 year surgiversary) and it was pretty much okay. I can get the doctor to pull out the results and take a look at it with me on Thursday, I believe.

I did a little research, cause I remembered reading about post bypass dermatitis recently.  I found a question on the ASMBS member forum. 

Dermatitis Hyperformis after RnY gastric bypass - this was presented as a question to members of the American Society of Metabolic and Bariatric Surgeons members forum.  No one has submitted any answers as yet.
 Then did a google for this and found nothing!

then googled dermatitis after bariatric surgery and found this article whi*****ludes both dermatitis and arthritis as you had mentioned.  Please note that the article below is in reference to a BPD-DS.  A much more drastic surgery as compared to RnY. Dermatitis that is due to an autoimmune disorder is akin to atopic eczema.  Certainly hope they find an easy, fast treatment for you.

Sure is something to think about and be aware of.

Cure of arthritis-dermatitis syndrome due to intestinal bypass by resection of nonfunctional segment of blind loop.

Drenick EJ, Roslyn JJ

Medical and Research Service, Wadsworth VA Medical Center, Los Angeles, California 90073.

Many complications that followed jejunoileal bypass operations performed for the relief of morbid obesity were caused by bacterial overgrowth in the excluded blind loop. The arthritis-dermatitis syndrome was one of the common distressing disorders. The pathogenetic mechanism was thought to be an immune-complex-mediated process related to bypass enteritis. Antiarthritic medication was ineffective in most instances, and the skin lesions were refractory to treatment. A 45-year-old woman was suffering from the disorder as described above. She also had diarrhea, a low hematocrit, an elevated white blood cell count, and an increased sedimentation rate. Her nutritional status was satisfactory, presumably because of adaptive hypertrophy of the short functioning small intestinal segment. The patient adamantly refused dismantling of the bypass or any gastric restriction operations. Therefore, the blind loop, the source of her disease, was excised with immediate relief of all ill effects and restoration of normal laboratory findings. The patient has been entirely well since, and her weight has remained stable for one year.

WOW! So I do have something to ask my PCP. I want to find out if I have an elevated white count immediately. The allergist asked me if I had diarrhea but I don't so it's not that bad. So if I'm reading this right, it's an infection from the BYPASSED section of the intestines that are still hooked up but not functioning. Yikes. No way to get medication in there. I'd have to do the same as the woman in the study and refuse to have the bypass reversed. Now if my white count is high, indicating an infection, I wonder if antibiotics would work on that from the outside? Something to think about and consider.  I wonder if that's causing me to be cranky too. LOL. Probably just cuz I can "feel" something wrong with this whole thing and it bothers me.  Thanks so much for the information...I'll definately keep an update when I hear anything at all.  Sedimentation rate? Hmm. more to google but that's something I can do. Thanks again!

I thought I had read something about this being related to surgery too...Then I read the next post and sure enough!  There is was.  I sure hope you can get the stuff under control. Don't forget to come back and tell us the results... Good luck Anita

Sorry for the delay, hope you get this message.  Sed. rate is another indicator of inflammation or infection in the body.  It us often used in testing for autoimmune diseases.  I'm not sure about the antibiotics working on the bypassed section, although in theory, they should work.  I'm needing to do some more studying this.  I'm also going to get with one of our surgeons and see if he is familiar with this. Cindy

OK, the vite deficiency that first comes to mind is A, pellegra. Look it up. Get tested, rule it out.

The vites where we need to supplement over and beyond a multi:
iron
calcium
A, D, E
B1
B12
zinc

I was tested in August for Iron, Calcium, at least some of the letters...Including B12. But I don't believe zinc was on the list. I'll have my PCP get out the results when I see her on the 21st to be sure. I'll look up pellegra right now.

Not to be construed as medical advice, this list includes labs we have had performed as gastric bypass patients

* 10231 - comprehensive metabolic profile (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase)

* 84134 - pre-albumin

* 7600 - lipid profile (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256 - (hep panel, includes ALT (SPGT) & GGT)

* 593 - LDH

* 718 - phosphorous - inorganic

* 83735 - magnesium

* 905 - uric acid

*7444 - thyroid panel (T3U, T4, FTI, TSH)

* 1759 - hemogram with platelets

* 7573 - iron, TIBC, % sat

* 457 - ferritin

* 945 - zinc

* 921 - vitamin A

* 680 - D (25-hydroxy)

* 4052 - vitamin B-1 (thiamin)

* 84207 - vitamin B-6 (Pyridoxine)

* 7065 - B-12 & folate

* 83970 - serum intact PTH

*31789 - homocysteine, cardio

* 83921 - MMA

* 367 - cortisol

* 84255 - selenium



For diabetics: *496 - HEMOGLOBIN A1C





DIAGNOSIS CODES:
269.2 hypovitaminosis

244.9 hypothryoidism

268 vitamin D deficiency

250.0 diabetes

401.9 hypertension

276.9 electrolyte and fluid disorders

579.8 calcium malabsorption

579.8 intestinal malabsorption

272.0 hypercholesterolemia

275.40 calcium deficiency

266.2 cyanocobalamin deficiency

280.9 iron-deficiency anemia

269.3 zinc deficiency

281.0 pernicious anemia

281.2 folate deficiency anemia

281.1 other B12 deficiency anemia

285.9 anemia, unspecified





*579.3 surgical malabsorption*

This list looks very familiar but I'll really have to see what is on the report again. I had it in August after I had the testing done per my WLS surgeon's recommendation but went over it with my PCP so I'll have to get another copy and print off your recommendation and compare the lists..My PCP has been a really good resource as she recommended my surgeon (even after I'd picked him myself) so they work pretty well together. Actually, she's been my PCP for 12 years and is really pretty good about this sort of thing and listening to my concerns and ordering appropriate tests. I'm sure if we missed something on the list, she'll order it up for me.  I know I had my cholestrol tested along with the iron and B-12 but I really forget the other stuff. When the test results come back the things that are out of normal ranges show in red so it jumps out at you but the things in black...I just passed over those. But I'll know on the 21st..Definately.  Thanks for the list. It will really help.

I've posted it lots and others have posted this list. As long as it ends up on YOUR labs, I'm fine. LOL

The only ones that I'd say could skip to annual vs 6 months would be cortisol, MMA, homocystiene--once they're ok, annually is good.

The vites & minerals, SIX MONTHS. OR less.