Need some advice RE a friend's daughter

My friend's daughter asked to speak with me last year about WLS. So I went and was brutally honest with her because I do not think she is prepared for the surgery. She's 21, has not dieted ever in her life and I get the feeling really thinks this is a cure for her depression.

Well . . . long story short she definitely decides to have surgery . . . so I give her all the advice she asks for . . . none of which she takes.  I suggested she see my surgeon. She did but Hershey would not let her into the program until she had 6 months of psychological counseling. She refused and found a program to take her. She's schedule for 1/17. She has asked me to be her angel and I agreed because I am the only support she has. I have advised her to join a support group, I've begged her to come here, she's just not doing any of it. She's lost very little weight pre op--she doesn't see the point even though I've explained the liver thing  and changing her behavior. . . Honestly, I feel she's doomed before she even starts. How can I best support her after her surgery? I know she is NOT prepared mentally. She thinks she's taking the easy way out. She's an adult and I have to respect her decision but I would also like to help her as best as I can.

Sounds like a typical 21 year old........she must like to learn things the HARD WAY!  (I know I did......still do....LOL)  Like you said she is an adult and she will make her own decisions.  All you can do is share your knowledge with her when she asks for it.......and hope that maybe someday she'll understand where you are coming from.  She will find out soon enough that it isn't the easy way out....and she'll probably be knocking at your door......Maybe brutal honesty will work with her???  Whatever the case don't let her bad decisions for her own life bring you down......YOU ARE NOT RESPOSIBLE if she fails!  Who knows though.......she may surprise you!

This is so scary, Bonnie. I can only imagine the damage she may do if she doesn't take the vitamin side seriously. I guess at an immature 21 "a slow and painful death" wouldn't get her attention either.
--gina

Gina,
You are knowlegable about this stuff, so I have a question:  With RNY we all know there is the malabsorbtion problem. But how does it work if a person just eats through their surgery (as this young woman might) and then returns to eating as they did before surgery, eating lots of food (both good and bad), etc.  Will the sheer volume of food going through her system allow her body to get the nutrients it needs?  I know when you sign up for RNY surgery you are signing up for a lifetime of vitamins and suppliments, but how do things change in this regard if you go back to your old lifestyle?  i've often wondered about this when I see celebrities regain their weight, and now I am thinking of this girl. 
Thanks! Kathy

You can't eat enough to over come the bypass of the duodenum. Your remaining small intestine will adapt and absorb more macro-nutrients that it's designed to absorb but not the micro-nutrients the duodenum is responsible for converting and absorbing. You can't eat enough calcium and vitamin D3, we can't convert beta carotene to vitamin A, we can't convert K1 to K2....so without calcium, D and K2, there goes the bones. I don't know if RNYrs ever adapt enough to produce enough intrinsic factor to absorb B12 but what to do in the years before even if you do? B12 can tank pretty darn quick. Night blindness from deficient vitamin A, anemia from lack of absorbable iron. It goes on and on. Vitalady can tell you some horror stories of proximal RNYrs who haven't supplemented in several years.

--g
  

Wow-
The - - woosh - - you just heard was all that information going over my head.  Now that I've read it a second and third time, I got it.  But What do you mean by:  I don't know if RNYrs ever adapt enough to produce enough intrinsic factor to absorb B12 but what to do in the years before even if you do? B12 can tank pretty darn quick. ?

Intrinsic factor (IF) is produced in the stomach and is needed for B12 to absorb. With our reduced stomachs/sleeves/pouches we don't produce enough IF so that we can absorb B12 by eating it. (thus shots and sublingual B12) So, if our sleeves and pouches stretch out over the years, will they start producing IF? I highly doubt it.

Follow the link to a graphic that shows where micro-nutrients are absorbed. https://docs.google.com/present/edit?id=0AU46vLsRDC9rZGhranh tcXpfMTRkc2JqaHNndg&hl=en

See the dotted line? My malabsorption with the DS is all the way into the ileum. Your proximal RNY is into the jejunum. See what's absorbed in the duodenum? You never get that back as long as you're bypassed. The ileum absorbs some of those vitamins but it doesn't do a very good job of converting K1 to K2, D2 to D3 or beta carotene to vitamin A.

--g

P.S. sorry OH ate my first post and I'm not using spell check....

That chart is very alarming. It's not that this information is new to me, but in making my decision to have WL surgery I chose to bypass a lot of the nitty gritty information about exactly what happens and put my faith in others to research the safety of it. I just don't like to deal with the details when it comes to my own health issues. (I am extremely thorough and on top of any health issues my children are facing though).  I think because I've had to deal with some other major problems in the past 10 years that required major surgical interventions, I have learned to put my faith in my doctors (and my husband who is a well-trained physician).  If they gave me the green light and said things are safe and have a long term positive outcome, then I was satisfied. It was easier for me to just not think about the upcoming surgery and any possible complications or I would have been a mess. This way I just went with the flow and I did okay. 
In the case of choosing to have RNY, I also "delegated" the worrying to my dh and I trusted the statistics for long term efficacy and safety.  But as I am watching my hair fall out and as I read stuff here, I think to myself...Good grief, what have I done?!  Is it possible to reverse a RNY and have Humpty Dumpty put back together again? I'm not sure I would want to but wondering if it's possible.

Your hair is falling out because of the ketosis not vitamin or protein deficiency at this point. Don't get scared about that. If you need the textbook source for that chart it's Advanced Nutrition and Human Metabolism by Gropper, Smith and Groff. 5th Edition, page 51. 

Not sure why you would delegate knowing your new anatomy to anyone but yourself but you gotta start learning...sooner is better. 

It is possible to put Humpty back together again if you have your remnant stomach.

--gina

I just don't pay much attention to it. I went through life rarely going to the doctor... never sought treatment for any of the menopause stuff. Have always been very healthy except for some major spinal cord injuries, which were out of my control. I was never taken to the doctor as a kid either.

Re, putting HD back together again. I wonder if the organs regenerate and start working again to absorb nutrients etc. Any knowledge of this?