OKCPirate

Bariatric Dietitian Elizabeth Anderson explains why feeling sunshiney is the perfect reason to keep visiting your local phlebotomist.


New Year, new calendar, time to enter in to your digital devices all those reminders and important events for 2017.
Birthdays, anniversaries, car inspection and for bariatric post-ops…don’t forget your LAB WORK!
I know this is one of the first things that gets forgotten in the avalanche of to-do’s in the first year after weight loss surgery.
As a bariatric dietitian, I try to make it easier for my clients by sending reminder emails and letters to them and their PCPs.
Many of my clients will say, “Elizabeth, I’m healthier than I’ve ever been; I feel great! Why waste time and co-pays on lab work?”
Short answer? It’s critically important—no matter which procedure you had done.
The American Society of Metabolic and Bariatric Surgery (ASMBS) recommends lab work after bariatric surgery at 3 months, 6-9 months and 12 and 18 months. After that, an annual work-up is usually sufficient.
Here’s why:

Vitamins and minerals play many key roles in weight management. If you don’t get adequate amounts, you’re compromising your health and slowing down your weight loss.
Gastric Sleeve, Gastric Bypass and BPD surgeries ALL change your metabolism. This means the digestion and absorption of nutrients, vitamins and minerals can be negatively affected.
Some nutritional deficiencies lead to severe consequences--some irreversible and at least one, fatal.
Nutritional deficiencies continue to occur after surgery—some as far as 20 years post-op.
a. Iron deficiency is most commonly seen 4+ years after surgery!
b. Dietitians in Boston, MA report that in one group of post-ops—43% were B12 deficient 15 months after surgery.
Many patients are deficient in key vitamins before surgery.
a. One study showed 48% of WLS patients had at least one nutritional deficiency before surgery! (1)
b. Another study showed more than 50% of all WLS patients are low in Vitamin D preoperatively. (2) It’s safe to say those pre-op deficiencies don’t improve with weight loss, reduced calories and smaller meals.
I send my patients to their doctors and NPs with this list of recommended labs:

ü Thiamine
ü Folate
ü Vitamin D
ü Vitamin B12
ü Vitamin B6
ü complete protein
ü complete metabolic panel (CMP)
ü complete blood count (CBC)
ü Lipid panel
ü Liver function tests
ü Parathyroid hormone (PTH)
ü Bone density test or (DXA) every 2 years. More often than I like, providers will pick and choose from the list. They too, wonder if all the tests are truly necessary.
I gently push back with the research data and thankfully, more labs are ordered.
When the labs come back, make sure your bariatric dietitian or some member of your bariatric team reviews them.
Many healthcare providers aren’t well-versed in the nutritional concerns after WLS and might miss an important trend.
I know regular labs are one more thing on the to-do list, but remember, you made a life-changing investment in yourself and your health when you had bariatric surgery.
Consider all those vials of blood just part of your insurance policy protecting that investment!
-Elizabeth Anderson MA, RDN, LD

References:
1. Ernst B et al. Obes. Surg 2009;19(1):66-73.
2. Gehrer S et al. Obes. Surg 2010;20(4):447-53.

I realize that testing hormone levels via blood tests are kind of hit and miss, but as a guy, I can tell you it was really critical. Pre-surgery my testosterone level's were really low. So I was receiving supplementation, the first few months following surgery the T levels spiked during the hormone dump (rapid fat loss led to everything stored in the fat cells to bounce into the blood stream). Now everything has leveled off. If I had just done a "one and done" blood test we would have missed this. And too much T can cause blood clots, and actually make it difficult to do aerobic exercise. If you don't have insurance, check online, there are places where you can get the blood work done affordably, and you can take the results to your doc and NUT.

@@Connie Stapleton PhD - Thanks for the clarification. I understand the warnings and advice to abstain to maximize success. The tone just comes across like this scene from Mean Girls:
The term toxin is loaded, pejorative and a bit misleading. Tylenol is toxic. Vitamin D is too. Both can be hard on the liver and fatal in high doses. But these are acceptable risks in moderation. Alcohol is rough on the liver in high doses. It can be fatal in the most extreme cases. There are risks in sex, driving, and even walking on a treadmill, so I heed the cautions.
And to be clear, when I discuss this subject with fellow WLS people, I do share my cautions based upon my experience, research and warn of possible red flags and dangers signs to watch for. It is a danger area. Alcohol may have put me in a stall, but that's why I am abstaining for a season to test this out.
In short, I don't disagree with your message, just the words (rhetoric in the classic sense of the word). Thanks for what you do, and I do have a great deal of respect for those of you who work with people in recovery from substance abuse. It is a tough job, where you know most are not going to succeed and it is often heart breaking work, so take care of yourself too (this is a major part of my sister's work, and I always remind her "there is a reason why the airline tells you to put on your own oxygen mask before you put one on those around you, and don't forget it.").

Pre-surgery I could eat egg drop Soup with chop sticks.

@ I bought two new office chairs because of that problem. The best was a mesh one. But the standing/adjustable desk was the best investment I have made to take care of the problem.
BUTT, that has been the biggest skinny problem. I can't sit for long now.
My GF and I have turned my small stomach into an advantage, we just split meals.
I have always been hot natured, and have never been really cold.
Ladies, when ever you get annoyed at shaving your pits, bend over and trim your toenails...not having to plan for that ordeal makes the whole thing worth it

@ I bought two new office chairs because of that problem. The best was a mesh one. But the standing/adjustable desk was the best investment I have made to take care of the problem.
BUTT, that has been the biggest skinny problem. I can't sit for long now.
My GF and I have turned my small stomach into an advantage, we just split meals.
I have always been hot natured, and have never been really cold.
Ladies, when ever you get annoyed at shaving your pits, bend over and trim your toenails...not having to plan for that ordeal makes the whole thing worth it

@@rydersmama i normally say... well i guess you better get to dieting then... cuz god for bid im skinnier than you.... lol
I particularly love the ones that use to be skinny and talk crap about fat people, but now themselves are "fat"... this was how that last conversation went:
Me: Hey girl, hows it going? Her: OMG Chris, look how tiny you are. Me: I know right. Her: your so skinny, how much weight did you lose? I hope you don't plan on losing more, then you'll be too skinny Me: 100lbs Me again: but , girl how much did you gain? Normally shuts them right up... Bam, drops mic... Exits stage.

I will gladly take the skinny people problems
My husband has named my faux fur body pillow my" boyfriend". I place it between my boney knees at night. It takes the pressure off my lower back and keeps me warm.
Tell me restaurant's use hard wood chairs to make you eat quickly and leave. Hard chairs are not my friend. I hope doing squats at the gym will give me some butt padding soon. In the meantime I will sit on my husbands jacket.
I tried to use body weight to pull some tall weeds from by back property. It used to be easier to lean backwards and the weeds pop right out of the ground.

@@finding_onederland
Lol...I had the exact same experience. After I had lost about 60lbs, I started to feel 'lumps' on my chest.
I thought to myself "oh great, now that I'm finally losing weight and getting my life in order, I've got cancer"....turns out it was my sternum! God I'm an idiot!
Sent from my iPhone using the BariatricPal App

I missed this thread because I wasn't that heavy, but it is all great stuff. Had lunch with a buddy who could use this and it is very inspiring. all of you great work and it inspires me to greater heights.

I began the bariatric process last summer. I thought I remembered it being in June, but it was actually the beginning of July 2015. I weighed 478 pounds. On high blood pressure & cholesterol meds. Been suing a CPAP machine for 10 years prior. Had a herniated T-12 disc, spinal stenosis and severe advanced arthritis in both knees.
I had the sleeve surgery in mid October 2015. Surgeon also repaired a large umbilical hernia at the same time (third surgical repair for the same issue). I weighed 422 lbs on the day of my surgery.
Hospital stay was short....released the next day.
Came home and recovered. Slept in a recliner for the first couple weeks. I highly suggest this, too. So easy to get in & out of....and very little stress on the abdomen.
There have been absolutely zero complications from my sleeve surgery. The hernia repair is not doing well, but I was advised to think of it as a temporary repair that would have to be addressed as the abdominal muscles were no longer being pulled outwards by excess fat and gravity. I go back at the one year mark to see where I'm at with the hernia.
I feel good....great on some days. The back is healing on it's own. Arthritis is more tolerable. Blood pressure meds are cut in half. I don't snore near as bad. I used to take 800 mg of Advil twice a day just to get around......now I go through most days without taking any.
I exercise by walking and through some light weight training. I am limited in the movements I can make due to healing back and pending hernia stuff....but I get around the gym and do the stuff that feels good.
I now, for the first time since high school, weigh under 300 lbs. I am closing in on my goal weight and have high confidence that I'll beat it and live at a lighter, more lean weight. I'm very happy with all aspects of the progress and can say without reservation that I would do the sleeve surgery again without a seconds thought.
My surgeon has given me very simple yet effective instructions to follow and as long as I do so.....the scale number keeps getting smaller.
I'm very grateful for this.
My only regret is not doing this sooner. Much sooner.
You are doing the right thing in doing your research and making sure you are getting the best from your surgeon and best nutritional advice upfront. The sleeve is very easy to live with and the weight loss is is going to happen for you.

I started at 515, sleeved july 15 (laparoscopically by a robot!). I too had 4 weeks of liquid pre op, worst...time...ever... I felt like an addict going through withdrawl, oh wait, I was! Very fast recovery. I have only felt weak twice, too long a period of time in between eating, and not enough protein. I started water aerobics 3 months post op. At 6 months, Dr. said "out of the pool!" I do aerobics/Zumba 3x per week, Weights, jogging a lap in between sets 2x-3x per week. Am jogging/walking a 5 k May 1. Rode my bike for the first time in 20 years last sunday. FEEL GREAT, don't LOOK too bad either! In 8 lbs I will break into the 200's. Ye-F-ing-Ha. I still have 100 to go, but the task doesn't seem so daunting now. Good luck, and keep us posted as to your successes and challenges.

First post here on bariatric pal, but have been reading for a while now and this topic is great to read.
About my self I am 37 I started down this road in January weighing 525 lbs. I had my Surgery in March and am 4 weeks post op and down 425 lbs. The only co morbidity that i had was sleep apnea. So far everything is going great stating to feel good agian and regain my energy levels and plan on starting back up the gym routine next week. I like reading about the post from us big guys and how well you guys are doing it keeps me going and knowing that it isnt just a pipe dream. Thanks everybody and keep the stories coming.

@@BigTink2LilTink Incredible. You deserve the rewards of your hard work.

Guys, this thread is really great. I started this journey at 419 pounds and I'm a week away from my 5th of 6 dietician meetings. I'm currently at around 385, just from following the pre-surgery diet.
I go through so many of the same issues with restaurants, airplanes, folding chairs, etc. And I absolutely always go for aisle seats, just so I can lean to one side.
My surgery date is going to be sometime in June, and I'm glad to have found this message board.

I'm 35 and had gastric bypass. Started at 425 with diabetes, high cholesterol/triglycerides, high blood pressure... and probably sleep apnea though never tested. I just passed 6 months out and have lost around 150 pounds. Best decision I ever made. Daily life is 10 times easier. My surgeon had no reservations regarding doing surgery. I did the standard 2-week liquid pre-op diet that he prescribes to everyone. It was tough, but I stuck to it. Surgery was one morning, and I was released the next day around noon. Was off of pain meds within 2 days... and back at work (desk job) by day 6 post-op
Weight came off quickly. I've never had any serious complications. Never had issues introducing new foods when my post-op diet allowed for a new phase. Only time I ever dumped was when I overate a little bit due to eating too fast.
Energy is through the roof, I'm off of most of my meds, and will likely be off all after my next checkup. I sleep much better, and apparently hardly snore anymore. I've gotten back to doing things I haven't done in 10+ years, like assisting on the ice with my kids hockey practice. I no longer worry about stuff like "does that restaurant only have booths" or "I hope they don't have folding chairs at my kids school play." I've flown on an airplane again no needing an extender and with the arms down. I don't sweat the minute the temp rises above 65 deg F (in fact I'm cold all the time.) Sex is much better. I could go on and on. Only negative thus far has been my weight loss has started to slow at 6 months out... but I also am not putting much effort into working out, so once I kick that up, I'm sure it will improve.

@@Ignatius I dealt with exactly the sorts of things that you describe, skipping events because of being worried about seating, avoiding flying, etc. The weight was so debilitating. My job is one where I get a lot of opportunity to travel to some pretty interesting places. Because of my weight, I skipped free trips to Turkey, Sweden, and the Republic of Georgia just in the past couple of years.
I had my surgery in November 2015. Due to my high weight, I had to do the pre-op for 4 weeks. That was hard, but I stuck with it and lost 46 lbs during that period. Fast forward to now, almost 5 months post-op, I am down 166 lbs. More importantly, my diabetes in full remission and I am off of all medicine. The arthritis in my knees is substantially better. I do a lot of walking and now can get out and enjoy things with my wife. People don't stare at me anymore when I am out in public. Everything is easier, despite the fact that I still have another 100+ pounds to lose. I have absolutely no regrets.
The surgery was scary, but turned out to be easier than I thought it would be. I recovered quickly enough that I was released same day by my surgeon. I was sore, but the pain was never enough that I felt the need to take pain medication. I knew that surgery at my weight came with a lot of risks, but I figured that staying at 518 lbs was likely to be a lot riskier. The guys on this forum we a real source of inspiration for me when I got cold feet or wondered if this would work for me. Best of luck, just thinking about getting some help is a really big step to take. I wish that I had been smart enough to do it when I was younger.

My highest was 388? So not exactly 400 or over, but close.
Many doctors will not perform the surgery if you way over 400 lbs. So just look around and see if you can find one will will do it.

@ I bought two new office chairs because of that problem. The best was a mesh one. But the standing/adjustable desk was the best investment I have made to take care of the problem.
BUTT, that has been the biggest skinny problem. I can't sit for long now.
My GF and I have turned my small stomach into an advantage, we just split meals.
I have always been hot natured, and have never been really cold.
Ladies, when ever you get annoyed at shaving your pits, bend over and trim your toenails...not having to plan for that ordeal makes the whole thing worth it

@ I bought two new office chairs because of that problem. The best was a mesh one. But the standing/adjustable desk was the best investment I have made to take care of the problem.
BUTT, that has been the biggest skinny problem. I can't sit for long now.
My GF and I have turned my small stomach into an advantage, we just split meals.
I have always been hot natured, and have never been really cold.
Ladies, when ever you get annoyed at shaving your pits, bend over and trim your toenails...not having to plan for that ordeal makes the whole thing worth it

@ I bought two new office chairs because of that problem. The best was a mesh one. But the standing/adjustable desk was the best investment I have made to take care of the problem.
BUTT, that has been the biggest skinny problem. I can't sit for long now.
My GF and I have turned my small stomach into an advantage, we just split meals.
I have always been hot natured, and have never been really cold.
Ladies, when ever you get annoyed at shaving your pits, bend over and trim your toenails...not having to plan for that ordeal makes the whole thing worth it

I thought if I would loose weight, I'd stop sweating so bad. Pre op I lost 23 lbs, post op I lost 38 lbs...so I've lost 60lbs....still sweat all the time....I'm in wk7. I have a long ways to go, but hurry up cold...I dream of being cold all the time. Sweating is so embarrassing.
Sent from my XT1650 using the BariatricPal App

I have to sympathise with the feeling cold thing, I am terminally freezing and wear more layers of clothes than ever before and yes I also have bony butt and general overall bonyness but I wouldn't change it for anything.

I had some of these! What got me is when I went to Disney and my spine hurt so bad from all the plastic seats on rides! I told my (insanely skinny) bff and she was like see there are cons to being skinny, but it's better than the alternative. And she was right!
Sent from my iPhone using the BariatricPal App

Heck I'm only a month out and although I expected the cold I didn't expect it so soon. My butt, my butt... I need a much better office chair now. Also the pain in my back from posture changing, ouch!