BigDrew

I'm a physician assistant who had orthostasis for the first two years or so (now 4 yrs out), now just occasional. I've looked into this as much as possible and never found a good answer. One issue is the studies that evaluated adverse effects of surgery didn't include this issue in their outcomes, so there is essentially no data. I have looked for case reports, etc. but found very little, certainly nothing that made sense. My surgeon had no idea. At one point, they thought I might have a pituitary tumor because one of the hormone levels was elevated, but it turned out to be elevated BECAUSE of the low blood pressure, which is what is supposed to happen. The last time I saw my internist my BP was 84/62, and I felt "a little" dizzy here and there that day. Generally it runs in the 90s.
The way I've come to think of it is that there is "something" that leads obese people to be more likely to have hypertension. But when I was obese, my BP was normal. Now that obesity is absent, whatever "factor" that pushed my BP into the normal range is gone, leading to low BP. I read food labels looking for the MOST salt in a given item rather than the least. That has been helpful for me. I wish I had a better answer. Good luck!

Make sure you guys are getting ferritin levels checked, and not just depending on your RBCs and hemoglobin to make sure your iron is ok. Mine were on the edge, but still normal when my doctor ran ferritin levels and my iron was VERY low. This can cause fatigue and a host of other symptoms.
And yep, I take my iron like I'm supposed to.....but managed to get iron deficiency without anemia anyway... because I donate blood a lot, still menstruate, and eat a mostly vegan diet.
Anyone suffereing low BP, fatigue, lack of stamina....get the full iron panel. Since I've been taking more iron and watching my diet, quit donating so much blood....my stamina is off the chart...terrific energy...and my hair is amazing.

i'm at two years and have noticed a lack of energy. In my case, I think it's the fact that I'm still not physically fit, although I'm quite slim. I had hoped to join a gym and start a regular fitness routine when I reached maintenance, but COVID had other plans. That will be my next goal.

Though not quite as far out as you, I still have issues with energy & low blood pressure.
I seem to feel weary more quickly than I did before surgery. And no it’s not a lack of fitness weary. I’ll be out doing chores or something & than suddenly think, nope had enough. Can’t do anything else at the moment. It’s hard to describe how it feels. It’s certainly not debilitating. I’m not puffing. My heart’s not pounding. Just feel weak. Sometimes just sitting for 5/10 minutes is enough & I’m right to go again. Is this how you feel?
The postural low blood pressure is just something I live with though it’s probably not quite as bad as it was. Maybe a 25% improvement in the last couple of months. I’ve always had a tendency to low blood pressure & when I’ve been slim before (in the 60kg range) I would have the vision loss & slight light headedness on standing a few times a month versus the several times a day I have it now. My GP prescribed a medication for low blood pressure but it did not help at all. I do all the sit up & stand slowly & wait before walking but it doesn’t really help. I sometimes bend over so my head is below my heart. Friend the deep breathing thing too but they don’t really help either. I just make sure I have a wall or furniture I can grab when it hits so I can ground myself. I’ve also be known to grab onto friends - in a non sexual way of course lol!
Hope someone has some ideas too.