ASMBS ER Sheet

On January 8, 2011, in Uncategorized, by Andrea

There are few things I tell people they MUST do.

You MUST get your own labs and put your own eyes on them to track trends.

You MUST learn how to stand up for your health.

Now?  You MUST go and print off a copy of the ASMBS Clinical Pearls for Emergency Care of the Bariatric Surgery Patient.

Yes.  I mean it.  Go. Do it now.  And put it with your list of medications and supplements and last labs for any emergencies that might pop up.

You never know when you might need it.

It could even save your life.

Celebrate Goodies

So back in October (yes, I realize it’s almost January..) Vic from Celebrate sent me a care package of some of Celebrate’s newer products.  It included a bottle of their Pineapple-Strawberry multivitamins, Cherry Tart calcium, Cherry B12 sublinguals, and their full line of ENS liquid multivitamin/calcium mixes.

I was in bariatric heaven.

Since I got a full month of the multivitamin, calcium, and B12, and because I’m not normally one for chewable vitamins?  I decided to actually TAKE the vitamins for a full month before doing the reviews on the products to see when I got tired of them, IF I got tired of them.  This is coming from someone who thinks Flintstones take like crap, could not stand Optisource, etc.

First up?  The Pineapple-Strawberry multivitamin.

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A neat little study that is in the latest JAMA looking at values from 25 hospitals and 62 surgeons performing RNY, VSG, and AGB.  Basically, risk is minimal, and completely unrelated to COE accreditation.  Also, there is some discussion in the full listing about the efficacy of COE accreditation (which is something I question as well).

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I believe in stronger testing and vitamin supplementation than this article, but this is pretty comprehensive none-the-less.

A few takeaways -

  • generally recommended that women avoid pregnancy until 12-18 months, or until weight stabilizes
  • oral contraceptives poorly absorbed after RNY and transdermal patch has decreased efficacy in patients over 198.4lbs (90kg); recommended use of IUC’s or injections with regular use of condoms for full efficacy
  • iron, B12, folate, and calcium deficiencies most notable problems in post-RNY pregnancies; no data to exist demonstrate higher protein requirements during pregnancy unless weight loss or fetal growth is slow
  • folate deficiency great concern due to neural tube defects – however deficiency is rare
  • post-RNY patients should be supplemented with 40-65mg iron, 1200-1500mg calcium citrate, B12
  • post-RNY patients may not tolerate traditional 50-gram or 100-gram glucose tolerance test due to dumping; rather do 2-hour post paradinal test
  • follow hemoglobin, hematocrit, serum iron, ferritin, erythrocyte folate, methylmalonic acid, albumin, prealbumin, serum calcium, phosphate, and 25-hydroxy vitamin D levels; erythrocyte folate is better indicator of true deficiency and MMA is more sensitive in detecting vitamin B12 deficiency
  • RNY may lead to serious GI complications during pregnancy, most notably internal hernia resulting in small bowel obstruction
  • most common complications following gastric banding were band leakage and band migration – both requiring surgical intervention

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WLS in the news

On January 22, 2010, in Uncategorized, by Andrea

A surgeon on a local news channel discusses the four types of surgery:

From WZZM13.com:

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