Madam Reverie

I'd start bleaching all of the surfaces you've touched.... Maximise your chances of not getting reinfected...

Chanelle, it is for the above reasons, that people were offering you empathy for your predicament.

Welcome to the madness

It might well be the cheese... that's fairly rich so recently out of surgery. Slowly, slowly. Rest, see how you feel and then its as you were!

Chanelle, my heart is going out to you. On doing a cursory search of the academic medical journals on pregnancy after bariatric surgery (because as of yet, I have not found one which encompasses 'surgery whilst pregnant' and I concede the procedures documented do not encompass VSG), I found the following. Go straight to the abstracts/conclusions to get the gist of the research and findings. Sorry to everyone else for the information splat taking up your screens. This is clearly not merely an issue of the fetus being exposed to radiation through an x-ray or the impact of the anesthesia on the fetus during the VSG procedure (which is not to be overlooked and if you'd like me to send you a complete article privately, I can - 'cause it's very long to post here and you'd need to read all of it to get the baseline). It is also about the severe nutritional, Vitamin and mineral deficiencies present in the first weeks after the operation which appear to have a significant impact on the progress of the fetuses growth and development in utero. A point that would need significant evaluation, monitoring and intensive hands-on care. If you would like to ask any questions on the below, please do not hesitate to contact me. Much love x Analgesia, Anaesthesia and Pregnancy A Practical Guide 3rd Edition By Steve Yentis Chelsea and Westminster Hospital, London By Surbhi Malhotra St Mary’s Hospital, London Publisher: Cambridge University Press Print Publication Year:2012 Online Publication Date:December 2012 Online ISBN:9781139012966 Paperback ISBN:9781107601598 Book DOI: http://dx.doi.org/10.1017/CBO9781139012966 Subjects: Anesthesia, Intensive Care, Pain Management ,Obstetrics and Gynecology, Reproductive Medicine Chapter 3 Anaesthesia before conception or confirmation of pregnancy Many women will require anaesthesia when they are pregnant and many will be unaware that they are pregnant at the time of the anaesthetic, especially in the first 2–3 months of their pregnancy. The thalidomide catastrophe initiated the licensing arrangements for new drugs and their use in pregnancy; the current cautious stance of the pharmaceutical industry is reflected in the British National Formulary’s statement that no drug is safe beyond all doubt in early pregnancy. The anaesthetist should have a clear knowledge of the time scale of the developing fetus in order to balance the risks and benefits of any drug given to the mother. A teratogen is a substance that causes structural or functional abnormality in a fetus exposed to that substance. Problems/special considerations The possible effect of a drug can be considered against the stage of the developing fetus: Pre-embryonic phase (0–14 days post-conception): The fertilised egg is transported down the Fallopian tube and implantation occurs at around 7 days post-conception. The conceptus is a ball of undifferentiated dividing cells during this time and the effect of Downloaded from Cambridge books Online by IP 129.215.17.188 on Wed Jan 29 01:41:58 GMT 2014. http://dx.doi.org/10.1017/CBO9781139012966.004 Cambridge Books Online © Cambridge University Press, 2014 drugs on it appears to be an all-or-none phenomenon. Cell division may be slowed with no lasting effects or the conceptus will die, depending on the severity of the cell damage. Embryonic phase (3–8 weeks post-conception): Differentiation of cells into the organs and tissues occurs during this phase and drugs administered to the mother may cause considerable harm. The type of abnormality that is produced depends on the exact stage of organ and tissue development when the drug is given. Fetal phase (9 weeks to birth): At this stage, most organs are fully formed, although the cerebral cortex, cerebellum and urogenital tract are still developing. Drugs administered during this time may affect the growth of the fetus or the functional development within specific organs. Management options The anaesthetist should always consider the possibility of pregnancy in any woman of child- bearing age who presents for surgery, whether elective or emergency, and should specifically enquire in such cases. If there is doubt, a pregnancy test should be offered. If pregnancy is suspected, the use of nitrous oxide is now generally considered acceptable, despite its effects on methionine synthase and DNA metabolism, as there is little evidence that it is harmful clinically. Similarly, although the volatile agents have been implicated in impairing embryonic development, clinical evidence is lacking. Some drugs cross the placenta and exert their effect on the fetus, e.g. warfarin, which may cause bleeding in the fetus. Key points The possibility of pregnancy should be considered in any woman of childbearing age. No drug is safe beyond all doubt in pregnancy. Further reading Allaert SE, Carlier SP, Weyne LP, et al. First trimester anesthesia exposure and fetal outcome. A review. Acta Anaesthesiol Belg 2007; 58: 119–23. 6 Section 1: Preconception and conception Pregnancy shortly after bariatric surgery. Transliterated Title: Svangerskap like etter fedmeoperasjon. Authors: Skogøy K; kristin.skogoy@nordlandssykehuset.no Laurini R Aasheim ET Source: Tidsskrift For Den Norske Lægeforening: Tidsskrift For Praktisk Medicin, Ny Række [Tidsskr Nor Laegeforen] 2009 Mar 12; Vol. 129 (6), pp. 534-6. Publication Type: Case Reports; English Abstract; Journal Article Language: Norwegian Journal Info: Publisher: Norske Laegeforening Country of Publication: Norway NLM ID: 0413423 Publication Model: Print Cited Medium: Internet ISSN: 0807-7096 (Electronic)Linking ISSN: 00292001 NLM ISO Abbreviation: Tidsskr. Nor. Laegeforen. Subsets: MEDLINE Imprint Name(s): Publication: Oslo : Norske Laegeforening Original Publication: Chistiania : Alb. Cammermeyer, 1880- MeSH Terms: Bariatric Surgery/*adverse effects Pregnancy Complications/*etiology Adult ; Bariatric Surgery/methods ; Duodenum/surgery ; Female ; Fetal Development ; HELLP Syndrome/etiology ; Humans ; Infant, Newborn ; Infant, Small for Gestational Age ; Obesity, Morbid/metabolism ; Obesity, Morbid/surgery ; Pregnancy ; Pregnancy Complications/metabolism ; Pregnancy Outcome ; Risk Factors; Time Factors ; Ultrasonography, Prenatal ; Weight Loss Abstract: Bariatric surgery is increasingly used to treat morbidly obese patients. Fertility in women may be enhanced after these procedures, owing to substantial weight loss and possibly a decreased absorption of oral contraceptives. We report a pregnancy that occurred two months after biliopancreatic diversion with duodenal switch in a 32-year-old woman. She subsequently developed haemolysis, elevated liver enzymes and low platelets count (HELLP) syndrome and had a weight loss of 43 kg (from the bariatric procedure) until the infant was delivered preterm by caesarean section (due to low activity). The infant was small in relation to the gestational age, with a weight of less than 50 % of the expected (780 g at 29.6 weeks). Histological examination demonstrated a small placenta with insufficient spiral artery trophoblast infiltration, possibly caused either by severe preeclampsia or by maternal nutritional deficiencies. Severe metabolic aberrations may complicate pregnancies after malabsorptive bariatric surgery. Patient preparations before weight-loss operations should include information on fertility and birth control in the postoperative period. Protocols for monitoring of patients that become pregnant after bariatric surgery are needed. Comments: Comment in: Tidsskr Nor Laegeforen. 2009 Mar 12;129(6):536-7. (PMID: 19291887) Entry Date(s): Date Created: 20090317 Date Completed: 20090319 Latest Revision: 20110330 Update Code: 20131125 DOI: 10.4045/tidsskr.09.34019 PMID: 19291886 Database: MEDLINE with Full Text The risk of adverse pregnancy outcome after bariatric surgery: a nationwide register-based matched cohort study Mette Mandrup Kjær, MD; Jeannet Lauenborg, MD, PhD; Birger Michael Breum, MD; Lisbeth Nilas, DMSc OBJECTIVE: The aim of this study was to describe the risk of adverse obstetric and neonatal outcome after bariatric surgery. STUDY DESIGN: Nationwide register-based matched cohort study of singleton deliveries after bariatric surgery during 2004-2010. Data were extracted from The Danish National Patient Registry and The Med- ical Birth Register. Each woman with bariatric surgery (exposed) was in- dividually matched with 4 women without bariatric surgery (unexposed) on body mass index, age, parity, and date of delivery. Continuous vari- ables were analyzed with the paired t test and binary outcomes were analyzed by logistic regression. RESULTS: We identied 339 women with a singleton delivery after bari- atric surgery (84.4% gastric bypass). They were matched to 1277 un- exposed women. Infants in the exposed group had shorter mean gesta- tional age (274 vs 278 days; P .001), lower mean birthweight (3312 vs 3585 g; P .001), lower risk of being large for gestational age (ad- justed odds ratio, 0.31; 95% condence interval, 0.15– 0.65), and higher risk of being small for gestational age (SGA) (adjusted odds ratio, 2.29; 95% condence interval, 1.32–3.96) compared with infants in the unexposed group. No statistically signicant difference was found between the groups regarding the risk of gestational diabetes mellitus, preeclampsia, labor induction, cesarean section, postpartum hemor- rhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. CONCLUSION: Infants born after maternal bariatric surgery have lower birthweight, lower gestational age, 3.3-times lower risk of large for ges- tational age, and 2.3-times higher risk of SGA than infants born by a matched group of women without bariatric surgery. The impact on SGA was even higher in the subgroup with gastric bypass. Key words: adverse pregnancy outcome, bariatric surgery, gastric bypass, pregnancy Pregnancy after bariatric surgery: a current view of maternal, obstetrical and perinatal challenges Ronis Magdaleno Jr • Belmiro Gonc¸ alves Pereira • Elinton Adami Chaim • Egberto Ribeiro Turato Received: 6 May 2011 / Accepted: 14 December 2011 / Published online: 29 December 2011 Ó Springer-Verlag 2011 Abstract With the increase in the number of bariatric surgeries being performed in women of childbearing age, physicians must have concerns regarding the safety of pregnancy after bariatric surgery. The aim of this review is to summarize the literature reporting on maternal, obstet- rical and perinatal implications of pregnancy following BS. Methods English, Spanish and Portuguese-language arti- cles were identied in a PUBMED search from 2005 to February 2011 using the keywords for pregnancy and bariatric surgery or gastric bypass or gastric banding. Results The studies show improved fertility and a reduced risk of gestational diabetes, pregnancy-induced hypertension and pre-eclampsia, macrosomia in pregnant women after bariatric surgery. The incidence of intrauter- ine growth restriction and small for gestational age are increased. No conclusions can be drawn concerning the risk for cesarean delivery and the best surgery- to-conception interval. Deciencies in Iron, Vitamin A, vitamin B12, vitamin K, folate and Calcium can result in maternal and fetal complications. Conclusions Pregnancy outcome of women who deliv- ered after BS, as compared to obese populations, is better and safer and comparable to the general population. Close supervision before, during and after pregnancy following bariatric surgery and nutrient supplementation adapted to the patient’s individual requirements can prevent nutrition- related complications and improve maternal and fetal health. Keywords Bariatric surgery Pregnancy Pregnancy complications Morbid obesity Weight loss Vitamin A Deficiency in Pregnancy: Perspectives after Bariatric Surgery Cristiane Barbosa Chagas1, 2, Cláudia Saunders3, 4, 5, Silvia Pereira1, 6, 2, Jacqueline Silva7, 2,Carlos Saboya8, 9, 6, 2 and Andréa Ramalho3, 10, 11 (1)Clinical Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (2)Center for Research on Micronutrients, Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (3)FIOCRUZ, Rio de Janeiro, Brazil (4)Nutrition and Dietetics, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (5)Research Group in Maternal and Child Health (GPSMI), Josué de Castro Institute of Nutrition, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (6)Clínica Cirúrgica Carlos Saboya, Rio de Janeiro, Brazil (7)Human Nutrition, Center for Research on Micronutrients, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (8)Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil (9)Brazilian Society for Bariatric and Metabolic Surgery, São Paulo, Brazil (10)Social Applied Nutrition Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil (11)Instituto de Nutrição Josué de Castro, Centro de Ciências da Saúde, Universidade Federal do Rio de Janeiro, Av. Carlos Chagas Filho, 373. Edifício dos Institutos Bloco J, 2° andar, sala 26, Ilha do Fundão, 21941-590 Rio de Janeiro, Brazil Andréa Ramalho Email: aramalho.rj@gmail.com Published online: 12 December 2012 Abstract This study aims to describe the clinical consequences of vitamin A deficiency (VAD) in pregnant women after bariatric surgery. Included are studies on VAD during pregnancy and after bariatric surgery conducted in humans from 1993 to 2011. There are few investigations on the relationship between pregnancy and bariatric surgery and on the damage to the binomial mother–child resulting from VAD in this relationship. The high percentage of VAD in the postoperative period is a cause for concern, especially considering the function of this vitamin in certain biological moments and in moments of intense nutritional demand. This vitamin serum evaluation is recommended during the prenatal period. Keywords Pregnancy Vitamin A Vitamin A deficiency Obesity Bariatric surgery Retinol Beta carotene Night blindness

I think this falls into the category of 'self identifiers'.. Such as 'divorced, parent, uncle, aunt, teacher, economist, etc. etc.' If you think it defines you - or has moulded you - insomuch as it has had one of the biggest impacts on your life and has significantly influenced how you are as a person now; then in some respects it would be natural to 'let it all out'. However and within that, (and maybe this is only applicable to me), I do feel an element of shame in my total lack of control when it came to my eating habits. Through having this surgery, I have sought to regain that control. Because of this, to discuss the surgery for me would be a step towards being 'vulnerable'. Letting the guard down on a highly personal issue of which I'm sensitive. This is not something I would consider doing early-doors in a relationship. I guess it comes down to what you feel sensitive about. If someone says 'I'm divorced with two kids' - then it is easy to comprehend the ramifications of this for an individuals circumstance and would give you a brief view into the window of any potential future (obviously with the variables of the current status of the ceased relationship, age of kids, etc. etc.) If you say 'I've had bariatric surgery' - for most people who have never suffered with obesity they would undoubtedly find it a bit left field, because it is not as 'common' as divorce. Consequently, it would be quite difficult for most people to assess how that would impact on that individuals' life (other than the weight loss) or how it might impact upon them (the person who has been told) in the future - if there's a future. On that basis, I'd rather avoid the possibility of 'Oooh, explain everything to me in minute gory detail' - because its not just about the 'cutting' element or the numbers. It goes far deeper than that. So for me? I'd rather wait and tell them when I got to the stage that I wanted to know their intimate histories and when I felt the knowledge of my vulnerabilities was welcomed and more importantly, safe within their hands.

I wrap up in so many thermal layers, I look as if I've not lost any weight at all. My 'fat' layer is now sponsored by The North Face

Hey, there's no shame in admitting how big you were, honey. We've all been there. Just think, in a perverse way, when you reach goal, it'll have such a bigger significance and magnitude of achievement. Hell, you're down 44lb as it is. That's bleedin' awesome!!! Chin up, chicken. You're doing brilliantly

Peace, people

hehe, totally normal. It'll last for a few weeks yet. Mine only does it now when I've eaten something spicy and then it'll chug back into action. As if its saying 'Oi?! What's this?!' Embrace the gurgling. Its just your body getting used to things. As above, if you're not in pain/discomfort/have a fever, its all good. It was a great source of amusement for my partner and I in the early days. Now its stopped, I really kind of miss it!

Ahh, but now you're witty, funny AND a hottie! Not a bad combination in my books! Watch out for the envy! x

Its a big kiss. With tongues.

Hehe congratulations. I hear ya. Great feeling When I went out for the first time, all dressed up with my man, I made friends with this girl who came and chatted throughout the course of the evening whilst in this pub/club. On discussion, I asked how old she was. Young. 24. She replied, 'but you're about the same age as me though, right? What? 26/27?' I am not that way inclined, but I could have snogged her!

550 a day at 6 months? Hells-to-the-no! From day one, after I'd got through the first 6 weeks, I was told to aim for 800-1200. I am still on that now at over 4 months. The only thing I count is Protein, the rest I leave in the hands of fate (don't worry, I'm not chowing down on chocolate, ice cream, etc.) I do it this way, because if I'm hitting my protein targets, there's not much room for anything else! As it stands and notwithstanding the obligatory stalls, I'm averaging a 2lb weight loss per week. A pretty good and sustainable loss. I felt crap-a-doodle-do on 500 calories. I also had to concede that a few carbs were necessary for me, too. On discussing this with the Nutritionist, he said 'Yes, younger people tend to need a few carbs and eat more regularly than older patients'. If I didn't get a few carbs in, I would fall as flat as a pancake and couldn't sustain myself energy-wise. As has been said, it is a very fine balance and you have to find out what works for you. What I was told from day one, however, is that 'you have to eat to lose'... Consequently, living off very few calories, in the end and as I was told, works against you. I'd be tempted to err towards the advice of the nutritionist myself. A surgeon is a whizz with a scalpel and can piece together (a stomach) or an engine - like a mechanic would. A nutritionist, should (and I emphasise the 'should'), be the guru who knows what to put into that engine to get the absolute best out of its performance. A corny analogy, but one that works in my head. Best of luck

Ahh! Glad to hear it! I smell gossip. Do tell! x

A-maz-ing

Clearly this was 'normal' physically, 'cause there ain't nothing else about you that could ever be considered 'normal', darlink Utter fabulousness could never and should never be considered just 'normal' xxx

Deleted - because I got too annoyed!

Feel free to say it as it is. You have EVERY right to. x

I'm 4 months out, am on drugs to stop my periods (because of severe PCOS), but have had three. First two lasted over 17 days each, the third, not so bad. 'tis our hormones going all over the place and is normal

You both look amazing - and very happy! Congrats to the both of you

I take the pledge too. This is a hysterical post! But where do you go to whine if you can't whine here?????? Not to Scotland. Damn skippy

<yawn>

Search for a thread called 'Dirty Little Secrets'... That was designed to fulfill that function - although it went completely off plot at points.

You look absolutely fabulous! Congratulations! May I ask as an aside though, what 'unwanted effects' did you have post surgery?