Long term consequences?

[CyclicalLoser 155]

Hello again everyone, I am pretty new here and have mostly been on the pre-op pages. I am in the process of getting cleared for my RNY bypass/revision from lap band placed 8 years ago. I am back at my lap band surgery weight, but the band has been wide open for a few years. Anyways, in preparing for this elective surgery, I have been very honest with myself about the extremely low (0.4% I see a lot) chances of dying with this surgery. After having the lap band, I also realize (somewhat) about long term effects from the band.

I am not near 600 pounds (I am about half that), but I watch "My 600# Life" to help motivate me to move forward with the progress. One of the things I saw on a recent show was dental problems caused by what I think was the bypass. Lately, it seems as if Dr. Now has been performing more VSGs (Probably in an effort to reduce anesthesia time), so it is possible it was a VSG. Being the inquisitive type, and just recently finishing graduate school, I went into research mode. I've found some indications that teeth erosion (Some coined it "Meth mouth") are common with any form of weight loss surgery. I've read several hypothesis for this, but I won't go into it. I suppose I'm trying to find out how widespread it is. Thus far, NIH peer-reviewed studies show some correlation, but I want to know from y'all if this is true. This is sad, but while I can afford the RNY surgery with my insurance, I cannot afford replacing teeth with implants. I've had bruxism over the last 30 years (Worn a night guard for the last ~8) and my lower molars are hanging on for dear life. I'm a sneeze away from 4 crowns as it is. Nevertheless, I don't want to "help" the teeth decay.

In doing this research, I found another discomforting parallel, the increased prevalence of esophageal cancer with WLS patients. I believe the main theory is that GERD is changing the cellular structure from repeated contact with stomach acid. The studies that I have read (At least what I can remember right now) included RNY in the groupings, which confuses me because my surgeon is telling me that there is zero stomach acid that can contact the esophagus. I would have expected this with the Sleeve patients, but not this. So my second question is how widespread is this? For people that have been on the boards a long time, does this affect many people?

Last question- Are there any other long term consequences from vitamin/mineral deficiencies, assuming one takes the daily supplements prescribed by the doctor? I'm wondering if the body is "stealing" Calcium from teeth since it doesn't get much any more?

Thank you in advance. I know this is a morbid/deep post, but I want to make sure I am well informed before I go through with this procedure.

[sammi123 116]

This is the first i have heard of this, about teeth going bad. Now i am terrified. I take really good care of mine and the thoughts of meth mouth makes me not wanna have by pass. I will do some research of my own. I went to a seminar yesterday and the dr's never mentioned this to us. It looked like they would had seeing how they mentioned everything else.

[Creekimp13 5,838]

44 minutes ago, CyclicalLoser said:

One of the things I saw on a recent show was dental problems caused by what I think was the bypass.

I saw that episode...and that dude's mouth had serious issues before he ever had surgery. The surgery might have put them over the edge due to Calcium malabsorption, but they were not healthy before hand.

Happy to report I've had no dental issues since my sleeve. Just went in (my husband says to have my fangs sharpened..lol...normal people call it a teeth cleaning) and got a clean bill of dental health.

I do think it's important to do two things though:

1. Keep up on your cleanings and check ups and floss well. Pay attention to your teeth.

2. Take your calcium and other Vitamins as directed and follow up with having your labs checked on schedule. At 3 months, 6 months, a year, etc.. Make sure you're not Vitamin D deficient, particularly if you live in the North where it's darker. If you are, make sure to correct your Vitamin D to a normal level so you can absorb your calcium. Go to your rechecks!

About the cancer thing....

First off, when reading your studies....make sure they are comparing incidence of esophogeal cancer in WLS patients to other obese patients.

Second....the bariatric community....WITHOUT weight loss surgery has higher esophogeal cancer due to weight related reflux.

Third....being fat is coorelated with dozens of other cancers and ups your odds of getting one.....so even if there was a little uptick of esophogeal cancer, you'd probably still be ahead with that risk than the risk you take being significantly overweight.

Fourth....experienced surgeons are doing a better job of tightening hernias and preventing reflux in sleeve patients.

Fifth...endoscopic screenings for esophogeal cancer could become a standard part of preventative care for WLS patients...and they're pretty easy to do....if more research determines more risk.

[CyclicalLoser 155]

Sammi, my post was not to scare others, I apologize it does sound like it frightened you. Everything I have found that is trustworthy show it is plausible. Some is conflicting saying that sugar-intake actually rises post-WLS, which I find a hard time believing. Nevertheless the Ketosis (Highly acidic, pseudo-alcohol breath) does explain it somewhat, along with acid erosion if people frequently eat until they vomit.

Here are the studies I have been looking at. I won't bother citing them because I'm no longer in Graduate school, but the authors are listed in these links.

https://www.ncbi.nlm.nih.gov/m/pubmed/29304473/

https://www.ncbi.nlm.nih.gov/pubmed/16989694

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467377/

https://www.ncbi.nlm.nih.gov/pubmed/26409987

This is for the esophageal cancer, a very, very small population, so I would take it with a grain of salt. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3016829/

[edit] I realize this is just a single piece of evidence here, and I intend to investigate it further.

Edited March 21, 2018 by CyclicalLoser
see edit line.

[Creekimp13 5,838]

Cyclical, I think you're smart to check out as much research as possible.

I do think you're jumping to a lot of conclusions, however.

Vomiting isn't necessarily something you'll ever do after surgery. I haven't vomited even once. Haven't experienced any nausea. Have overeaten a couple of times and felt things back up a little. Did a little walking and deep breathing and the sensation went away within a half an hour...and taught me to avoid overeating.

While people do typically hit ketosis during the liquid diet phase....you're only talking a couple weeks. You do not have to follow a ketogenic diet post surgery. I sure don't. Some folks do, and do great with it. But there are plenty of surgeons who will work with people who don't want to go the Keto route. My diet is similar to mayo Clinic Diet.

Calcium malabsoption could cause dental issues....but again, that's very manageable with monitoring and taking Vitamins.

My labs at 3 months were all perfect. Good Vitamin levels. Perfect sugar.

Obviously, results are going to vary and yes, there are risks.

But remaining obese is not without serious risk,either.

Risk-vs-Benefit...in my opinion....strongly favors having bariatric surgery.

[Creekimp13 5,838]

Your first study...consider why WLS patients might get more cavities.

It could be as simple as....more frequent exposure of teeth to food. When you're eating 6 little 200 calorie meals every day.....your teeth have more exposure to food than if you're eating a fast big mac, fries and a coke.

We're taught to eat very slow...chew like crazy...not to drink after meals.

All of these habits keep more food matter on our teeth longer.

This additional exposure could be eliminated (or at least reduced) simply by swishing with Water or brushing after all of our tiny meals.

Edited March 21, 2018 by Creekimp13

[CyclicalLoser 155]

9 minutes ago, Creekimp13 said:

[snip]

Creekimp13, I agree with all of your points, I really do. There are certainly a lot of pros and cons of it. In my case, my C-Reactive Protein is over 5, and that is off the charts for chronic inflammation, which is an outstanding way to have a fatal cardiovascular event, or just about any form of cancer. I'm just trying to weigh out (pun not intended) all of the options, benefits and consequences. I haven't heard about either of the aforementioned consequences in the books I've read, nor the information seminar. I do plan on checking with the nurse to see if she could get the surgeon's take on the studies. I'm confident he has seen them and determined that the benefits outweigh the risks, but nevertheless I still like to have all the bases covered.

And yes, that guy had said he had never been to the dentist, so I only used that episode as the "seed" for further research

I definitely agree that the key to success is proper follow-up and keeping an eye on blood levels and the EGD!

[Creekimp13 5,838]

I think with your particular issues caution is warranted. First, do no harm, right?

It never hurts to ask questions and do some reading.

How is your presurgical diet going? Have you been seeing a nutritionist? Might be a great place to start. Losing a little weight and getting your diet figured out before surgery really improves outcomes.

Very best wishes to you on your journey. Be well, and don't hesitate to ask the peanut gallery anything. We're not experts...but we have a ton of different life experiences to draw info from, and some valuable insight in the trenches so to speak.

Good luck!

[sammi123 116]

So is it best to start Vitamins before surgery? I take a multi Vitamin, fish oil, Calcium and B-12 now. I just had labs done and all was good. Should I be taking anything extra before hand?

[Creekimp13 5,838]

Good questions for your surgeon, Sammi. Each doc is different:)

[CyclicalLoser 155]

Thank you again for all of your thoughts and information. I haven't been doing as well as I should be, but that is entirely my fault and I've been logging my food intake and now have a fitbit (knockoff) that does help me track my steps. Over the last week I've been serious about exercising and do 20 minutes a day on the elliptical. I know that isn't very good, but I'm coming from being very sedentary, so it is enough to get my heart working pretty good. I intend to increase it more as time goes on.

I've been attending a monthly group nutrition/diet group. I'm thinking I need to push out the surgery - not for the surgeon, but for me to demonstrate to myself that I am willing to put forth the effort. I am down about 8 pounds, but we all know how hydration can really cloud the numbers.

Thank you again, I really appreciate it. BTW, I was a michigander for 20 years. Rochester Area when young, went to Michigan Tech and also Michigan State. I still have family there in the flint area. Moved out here because of the weather.

[Creekimp13 5,838]

I know the Rochester area well:) We're puppy raisers for Leader Dogs for the Blind:)

[Creekimp13 5,838]

I think your exercise efforts are awesome for someone who is staring from sedentary.

Keep track of your steps...they really add up. Add a couple hundred more every time you get too comfortable with your goal.

Walking has been a huge part of my lifestyle change.

When I started back in June of last year...I was walking less than 6000 steps a day. And my back, hip and feet were killing me. But I pushed a little more every week.

These days, I walk 5-7 miles every day and often more. My official daily step goal is now 12,000...which I can do in my sleep. I'd upped it to almost 20,000 and my doc told me to cut back and diversify my activity.

Walking changed so much for me. My endurance changed completely. My core strength. My back improved so much. And it really helped my weight loss when partnered with a good diet.

Have had good luck in the heated therapy pool, and doing some circuit training, too.

But mostly...I walk. It's simple, you can do it anywhere. No special equipment needed.

Don't underestimate it's power. Walking is where it's at:)

Edited March 21, 2018 by Creekimp13

[CyclicalLoser 155]

I'm not joking, I lived across Avon road. Unless they moved, I literally lived in the sub across the street. Small world. And allow me to pause to thank you for the work you do. Although I am not blind, I know they are instrumental for those that need them.

When I work out my fitbit-esque band (Huawei) doesn't track my "steps" on the elliptical that well, but I do get in a mile in 20 minutes. That's terrible I know, but that is what I "ran" when in PE in high school, quite a while ago. I now live on the side of a mountain, so making a trip around my neighborhood is a considerable climb, so it is quite a workout. I would say pre-exercise, I was at about 2500 steps a day. Now I am about 5300 or so. But I find other ways to work it in, I walk quite a ways when I park, and just today I walked down 6 flights of stairs.

[FluffyChix 17,409]

Ok, so the big question is whether you're looking to convince yourself NOT to have surgery and "try to lose it yourself" with traditional methods, or are you actually really completely gung-ho and wanting surgery, but have a few fears?

Cuz the 2 are diametrically opposed.

Doh. Sorry prematurely posted. I will continue in the next window with my research and point.

Edited March 21, 2018 by FluffyChix