swimbikerun

Great! Over there on the long term supplementation area, I posted about PPI's and vitamin issues.

Good - keep us informed on your progress welcome back to your son and hopefully it is after a successful time at school

Same here, I did gain some weight back, up to another size but with the edema, we're not sure if it is true weight gain or edema that's making the problem. My legs and feet swell and my belly is starting to go like the kids you see on TV.

Yes they are relatively speaking. This is why I say and say and say, you have to know your stuff because doctors don't. Its why I'm having a hard time. All standard tests. The other item is that you need to understand how doctors think. They look at the test and think you are fine, its in your head. The problem is that ranges took "supposedly" healthy people and took the averages. Now if you are one of those where the bottom limit is too low for you, there is where you can get sick or ill and the doctors think all is well. What doctors CANT do in terms of B12 is the fact that it requires intrinsic factor for the body to use it. Without a stomach or just a bit of one, they can't measure how much intrinsic factor we make for the body to be able to use it. THAT is the problem with B12 ... and I can almost guarantee you even a GI won't pick that up. Yes that is possible. I have a hematologist who is just plain BRILLIANT and monitors me but yes, I will hit on Iron and NO just checking HGB is not what they should be doing. I have been zinc deficient before, including iron deficient at the same time. It took 5 rounds of IV iron, a B12 shot AND a B1 shot before my iron started coming up months later. "vit D - well I was always low no matter how much I supplemented previous to weight loss. I am puzzled by that except it seems that obesity interferes with either Vit D absorption OR the test." That and you have to remember, they may not have been testing the right thing. I have 2 Vitamin D tests that have been done on m Vitamin D 1,25 Dihydroxy & Vitamin D, 25 hydroxy. https://www.aruplab.com/Testing-Information/resources/TechnicalBulletins/Vitamin%20D,%201,25-Dihydroxy%20and%20Vitamin%20D.pdf will give you an idea about these 2 tests. They are Vitamin D but test for different things. http://www.oaml.com/PDF/2010/OAML%20Vit%20D%20Guideline%20Jn%20162010%20FINAL.pdf Vitamin D gets metabolized in the liver to produce 25-hydroxy vitamin D2 /D3. These compounds then undergo further hydroxylation, primarily in the kidneys, to produce 1,25-dihydroxy vitamin D. Serum 25-hydroxy vitamin D is the analyte of choice for assessment of a patient’s vitamin D level. It is preferred because it reflects precursor levels of vitamin D derived from cutaneous metabolism as well as from dietary intake. In addition, when compared to 1,25-dihydroxy vitamin D, its concentration is an order of magnitude higher, is less subject to physiological variation, has a longer half-life, and correlates well with bone mineral density.

http://www.medscape.com/viewarticle/803376?nlid=31820_464&src=wnl_edit_medp_gast&uac=202973SY&spon=20 Proton Pump Inhibitors and Risk of Vitamin and Mineral Deficiency PPIs have been associated with an increased risk of vitamin and mineral deficiencies impacting vitamin B12, Vitamin C, calcium, Iron and magnesium metabolism. While these risks are considered to be relatively low in the general population, they may be notable in elderly and malnourished patients.

I want to highlight this - wonder how I can do this? http://www.medpagetoday.com/Endocrinology/Obesity/40490?xid=nl_mpt_DHE_2013-07-17 Gastric Sleeve Works Long Term In terms of complications, one patient had a leak, two had incisional hernias -- which were deemed unrelated to treatment -- and 11 patients had new onset gastroesophageal reflux disease, which typically resolved with proton pump inhibitor therapy. Over 5 years of follow-up, 77.9% of patients developed Vitamin D deficiency, 41.2% had Iron deficiency, 39.7% had zinc deficiency, 39.7% had a vitamin B12 deficiency, 25% had a folic acid deficiency, and 10.3% developed anemia. ***These deficiencies occurred "despite routine supplementation, in a higher rate than we had expected," the researchers wrote.***

Random B12 information (includes some folate) Causes of non-megaloblastic macrocytosis (megaloblastic meaning large immature erythroblasts that come from the bone marrow, due to defective DNA synthesis, normally either B12, folate or both deficiencies. Macrocytosis refers to a blood condition in which red blood cells (RBC) are larger than normal) Liver disease can cause these items, as B12 can be stored for years in the liver. Unless released due to problems with the liver, it is normally good for 2-5 years. Serum folate levels are normally taken but red cell folate is more specific. Serum B12 is NOT not always an accurate reflection of deficiency at a cellular level. This is why some patients have symptoms when the injections or pills are reduced, even with normal B12 levels. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570488/ http://www.medscape.com/viewarticle/410469_4 "A low serum folate level may indicate only a decrease in folate intake over the preceding few days. [26] A better indicator of tissue folate status is RBC folate concentration, which remains relatively unchanged while a red cell is in the circulation and thus provides an assessment of folate turnover during the 2 or 3 months preceding measurement. Also, low RBC folate levels correlate better with the degree of megaloblastic changes in the bone marrow than do low serum folate levels. When there is coexistent Iron deficiency, liver disease, serum and RBC folate levels may be normal -- and serum B 12 levels may be normal or even elevated -- but tissue Vitamin deficiency can be present. This is only demonstrable via subtle hypersegmentation and/or deoxyuridine suppression test and is subsequently confirmed by response to vitamin therapy. Decreased serum total folate-binding capacity is another test that may indicate hidden folate deficiency." An elevated MCV can be associated with alcoholism (and if you look for signs & symptoms of alcoholism, malnutrition, vitamin deficiencies, you will see bariatric patients that mimic those symptoms when deficient! Vitamin B12 and/or folic acid deficiency has also been associated with macrocytic anemia (high MCV numbers).

http://www.medscape.com/viewarticle/412220 calcium citrate Shown to Have Superior Bioavailability and Protects Against Bone Loss

Calcium carbonate depends on stomach acid for absorption, and is absorbed better with food. Citrate doesn't have that problem. Carbonate is 40% calcium by weight: citrate is 21% calcium by weight. You need more citrate than carbonate. Don't go higher than 500 mg at one time, it won't be absorbed. Carbonate can cause more GI problems than citrate. For all the yak on Tums, it has carbonate not citrate.

Here is where there is a problem I see with bariatric patients, that I think is totally correct from Michigan chic. Some of us do NOT need the supplementation based on WHAT you eat. I eat healthier than pretty much most vegetarians I know as pasta's and rices figure heavily in their diet. I use Vega, which tends to work better for me vs. pills. I have had all my levels tested and they are good. Each body is different. The problem I found was that my former surgeon only wanted to test his list, not what might be a problem for me. Another reason to find someone who is willing to be flexible as you are an individual person and not some cookie cutter "this is what everyone checks for, standard pat list, cattle call" type of thing.

MichiganChic got it right. So that being said, I'll going to address a few things I learned with whatever medical resources I have. Please note that I have a local medical school with the best librarians in the world, and I use those resources a lot. I realized I don't have all of them on me, so I'll go this weekend and get specific references. Always pays to ask your doctor as the references I have come to 2 different conclusions (regarding Protein binding of calcium, whether or not its charged on the negative areas or truely is free of the protein molecule itself). I'll try to keep to the "lighter" end of things so you get useful info rather than a lot of scientific snooze material (or as my sister calls it, my reading & video material). Calcium: Several ways calcium can be measured: Serum blood Ionized Urine (24 hour collection) Differences between blood levels and ionized levels is serum blood calcium (what you find in a BMP (basic metabolic panel)) is your total calcium level, whereas the ionized calcium is the free in plasma type only. ** My sources differ on this** Serum blood calcium measures calcium that is attached to albumin/globulins or Proteins AND the free or ionized calcium in plasma OR it attaches to the negative charged sites on protein OR it is bound to proteins, bound to anions, and free/ionized. Parathyroid hormone & Vitamin D regulate your calcium. However, the kidneys assist in getting rid of the excess, so if they are not functioning right, you can find this out by doing urine studies. Many molecules attach to proteins or other blood particles and use them as a sort of "ferry" to get to where they need to be. If you have problems with abnormal levels of proteins like albumin or globulin, this may be one reason you need ionized levels checked. I'll list some items here that would be pertinent to us. Normal ionized calcium levels with high total calcium levels is called pseudohypercalcemia. It can happen due to hyperalbuminemia (basically an edema type condition where the Fluid leaks from your cells surrounding the tissue) or excess Vitamin D. Normal ionized calcium levels with low total calcium levels is called pseudohypocalcemia. It can happen due to hypoalbuminemia from liver/kidney disease. Low ionized calcium levels with low total calcium levels can happen due to parathyoid issues, Vitamin D/Magnesium deficiencies, and high phosphate levels. High ionized calcium levels with normal total calcium levels can happen due to hypoalbuminemia, parathyoid disorders, or acidosis. High ionized calcium levels with high total calcium levels can happen due to parathyroid issues. I'll stay away from high levels because lower levels would make more sense to us, excess Vitamins A & D would probably be the main causes for us. If you have lower levels, hypoparathyroidism, malabsorption, osteo types of problems, but mostly Vitamin D deficiency would be the big issues. Increases in pH levels in the blood, aka alkalosis, will cause more of the calcium to bind to the protein molecules and will decrease your ionized calcium levels. Decreased in Ph levels in the blood, aka acidosis, causes less of the calcium to bind to the protein molecules and will increase the free calcium levels. I add this due to authors' interest, as since the surgery, metabolic acidosis and alkalosis seem to be my buddies. Acidosis in the hospital after the surgery, alkalosis doing a number of endurance athletic competitions. When you get these tests done, make sure to review things such as your other electrolyte levels, PTH levels, Vitamin D, and phosphorus & magnesium. A change in this electrolyte can cause or be influenced by changes in other electrolytes. Calcium is excreted out of the body in urine and feces (a few other things but those are the most important). An increase in pH, alkalosis, promotes increased protein binding, which decreases free calcium levels. Acidosis, on the other hand, decreases protein binding, resulting in increased free calcium levels. Total calcium measurements, as you've seen, can be misleading. If you have hypoalbuminemia, you will have normal ionized calcium levels but total calcium levels decrease. There are ways to compensate for that, what I cheat and do is look online for the medical calculators. If you have kidney or low bicarbonate or serum albumin levels, you should measure the ionized free calcium to diagnose hypo/hypercalcemia. A few of the reasons to test the ionized calcium would be liver or kidney issues, abnormal total calcium issues, parathyroid issues, numbness or muscle spasms around the mouth, hands or feet. Drugs that can increase your ionized calcium levels would be things like thyroxine. Drugs that can decrease your ionized calcium levels would be things like heparin, epinephrine, alcohol. Urine tests measure how much calcium gets excreted out by the kidneys. It can look for problems with the parathyroid glands or the kidneys, or to check and see where the body is getting calcium from. Normal levels for urine calcium can be anywhere from 100-150 to 300. A calcium free diet goes from 5-40, low diets are 50-100 or 150. High levels can be caused by kidney issues, taking too much calcium, too much parathyroid hormone, and very high Vitamin D levels. Low levels can be caused by too little parathyroid hormone, low Vitamin D levels, and not enough calcium and/or malabsorption. If you show up with higher levels of serum calcium, lower levels of urine calcium, and possible bone loss changes, what is happening is that your body is leeching calcium from the bones (bone loss), causing the higher levels of blood calcium, the kidneys are holding on to the little bit you have and not urinating it out (low urine calcium).

As long as you getting out there and exercising, the fact that you now CAN, isn't that something to celebrate? While I'm all for pushing ones' self to become better, lets take a look at the same thing and think how far we've come and celebrate the positives in our new lives.

Ok, thanks to CowgirlJane, I'm starting a thread on long term supplementation. I think I was going to go over Calcium and Vitamin D first. Then Iron supplementation and heme/non heme types. Vitamin K would be another one, as I bet people didn't know that some supplements don't have it. Any other suggestions?

Can you stretch or just do boxing, the types of punches?

Cowgirl Jane - Sure 'nuf on starting a new thread but where would you all like to go? I could put some info I've learned together for you all. Just - put it in where? Do I need to ask Alex where is the best place? Btw, I do have sources, my doctors hate it when I quote to them.

Way to go my sister in Him! God will be blessing you!

With all due respect & apologies for the profanity, I have an image of a woman raising her arms and breaking the finish line tape that says, "Replace what if with He** yeah!" DO IT!!!

WHOO HOOO Congratulations!

Look, seriously, it is better to find out and get things taken care of than fart around (with all due respect and pardon my language) and have problems. If you know about stuff, you can know what types of help or the like you need, more appropriate & timely care. That has been my problem, way too many really don't understand the interworkings of everything and the effects it has on the body. Medical school does NOT really teach this sort of stuff and they don't teach problem solving. If you have something of a medical/science background with math/login/CS skills, that is why I can do what I can do & know what I know. I wont say who, but a local in the area who is a nationally big head cheese helped me out long time ago with the medical library. Those ladies at the library have been a Godsend. If I didn't know what to look for and ask and show people stuff, I wouldn't have gotten some of the care I did. After care can be a huge problem, and its better we know and fix it. I've had several people with cancer who paid the price for not getting things addressed.

WHOO HOOO this is great! Love to hear people getting out and active. Good on everyone for trying something that fits your new sizes.

Thanks. Tuna - yes now I've seen some of those tuna and you need upper body and core for that. Start working out .

No a Dexa scan isn't, but it does tell you if there are significant bone changes. If you have calcium issues, and I have close to every risk factor known to medicine, then you get it. There are blood calcium tests (serum and ionized) and urine calcium. The blood one is the quick one but does NOT tell the whole story. The ionized one is good or better, but the blood with the urine one is really going to give you the picture of what is going on. Its due to those that I get the Dexa scans yearly and I can guarentee you I will again after the significant drop in hip % and the risk factors I have. The problem is getting it done and getting someone who knows the whole deal to be able to read and interpret it. You need Vit. D levels at the same too, helping that out but also kidney function too. Its not just adrenal glands because the kidneys urinate out excess calcium. You want to be careful - when B12 is high, that can mean leukemias or liver diseases. Its because B12 is released during cytoloysis and/or decreasing clearance by a messed up liver. I had an internist who flipped at me but I was like you want the medical research? Its there. That's why you want to be careful about the education of the person reading bloodwork. As for reflux, yes, that's something they're finding out. Pernicious anemia ... yes but they need to look at all the factors and 99% of doctors, including specialists, wouldn't know how to read bloodwork. I mean read it in terms of the patient and in relation to everything else. Judging the patient and not reading the computer printout that says everything is normal. Patients who present with medical research and I mean serious research ... docs need to look at. Its not a matter of who has the degree, someones' ego, its about the health of the patient. Pernicious anemia is called that because you can die from it.

Yep, I had B1 in the ER, B12 in the docs office. I need K, its so low it never registered months ago. Calcium ... Here is a bit of medical info. This is straight out of the medical research. If your *BLOOD* calcium level goes up (doesn't have to high, just high for you), check the *URINE* calcium levels. Check PTH levels also. Mine were ok but blood calcium went up, urine calcium is below a calcium free diet. When that happens, check the bones and kidneys. Dexa scans last year were ok but this year one hip was lower but the other was significantly lower. Blood is high because the bones are getting leached. The kidneys aren't urinating the extra calcium out because the body is holding on to everything it can. Either that or the kidneys aren't right.

Yep, that sounds about right. Our own Miss Diva and Bariatric Pal staffer Susan both are converting or have converted to RNY because of reflux, so it is def. an issue for some. And since they were both further out when it occurred, it seems it can happen farther down the road, not as an immediate problem.

Tremendous! We have an annual 10K Turkey Trot here. Wicked 10K is good too.