I have a hatred of few things in life.  Flintstones, Tums, and Optisource are among them.

When I first had surgery, we were started on Optisource vitamins.  4x a day, that’s it.  Sounds fine, right?  It’s great — until you realize they have the wrong type of calcium in them.  They use calcium carbonate and not citrate — which is what someone who has a limited acid quotient has needs.

So then we switched.  I’m not really sure why, but we did.

To Flintstones and Tums.  Which is still the wrong type of calcium.

And then.  Then I had kids.  And it all goes downhill from there.  (doesn’t it always?)

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EGD.

On March 10, 2010, in Uncategorized, by Andrea

3/10/2010 Full sheet

Okay so I’m home and I’m still feeling pretty crappy — but not from the drugs exactly.  I have a crappy ass headache — either from a change of weather, a lack of carbs from the fast (although I’ve eaten?), a combination of the drugs and the above?  I don’t know and frankly I don’t really care at this point.  I just don’t feel good.

In any case, I’m back.  And because people want to know what to expect during these routine tests before and after RNY, thought I would document everything about it.

I got to the hospital (Franklin Regional Hospital in Louisburg, NC — and let’s be frank — it’s tiny, but decent) at 7:10am.  We’re a bit late — it’s a 45 minute drive, and it’s hard to get the kids up and around that early.  Shortly after, I go for labwork.  I’m a woman of childbearing years, so it’s “pee in a cup” time — but I’ve had RNY and I’ve not been allowed to have anything to drink since midnight so there is no pee to pee.  So I give her a vein.  She’s a bit shocked, but goes for it (and gets another 3 vials “just in case” they will need it.. I like this tech).

As soon as I’m done with that, I get called back to the pre-op area.  Kiss my kids good-bye (not because I’m worried but because Kaitlin gets sad if I don’t say bye).  Walk back, get changed, get my IV.  And immediately go back to the room.

This room, of course is pretty interesting.  Monitors, blood pressure monitors, cardiac monitors, computers, drug lockups, various equipment, nurses — some of which can be somewhat scary and intimidating.

I’m put on a cardiac monitor, a blood pressure cuff, O2, and oxygen saturation monitor.  While waiting for the doc, joke around with the nurses, but also discuss with the nurse why I’m there.  She’s familiar with RNY and by hearing what my pain is, she knows what tools to have on hand just in case there’s a suture that needs clipped or a staple that needs pulling, or whatnot.

As soon as the doc comes in, he signs the release for the meds and in goes the versed.  Pretty soon, I get a spray in my throat to help numb my throat that tastes horrible.  Another within a few moments — and yes I remember these.  I know she pops the fentanyl in and I remember asking if that’s what she pushed, and remember her saying “We’ll see you in a little while…”

I remember, for the first time, actually waking up this time, with the camera down my throat.

I’ve had several EGD’s — this being my 3rd with this doctor — and this is the first time I’ve ever woken up.

I know I panicked a bit.  I remember being told to calm down — and I remember seeing the nurse push more meds.

And then I remember waking up in recovery.

9/17/2008

I’ve included some photos for you from the two procedures.  I have to apologize — while we have multiple computers (6?), several game systems (4?), etc — we don’t have a scanner.  But we DO have two DSLR cameras so I can take photos of the photos..

First photos are from 9/17/2008.  These are the ones from when I had 3 ulcers on my anastomasis.  When looking at these photos, the white “spots” are the ulcers.

9/17/2008

9/17/2008 -- One large ulcer visible

9/17/2008 - Ulcer visible on the far upper left

9/17/2008 - All 3 ulcers visible (Largest towards the back, then one closest to front, and one to side)

So that’s what my pouch and anastomasis looked like in mid-September.  Was put on Carafate 4x a day and Prilosec 2x a day for a period of time — 3 months I think?  When I still had pain, we did exploratory surgery and discovered that I also had a ton of adhesions.  But it’s very obvious that I had quite a bit of ulceration.

Today?

3/10/2010

3/10/2010

3/10/2010

3/10/2010

3/10/2010

3/10/2010

So what does all of this mean?

Well, there are no ulcers in my pouch.  There is not irritation in my pouch.  In fact, I was told it was one of the cleanest, healthiest looking stomachs seen by the Nurse who was taking care of me (not the Endo nurse, the recovery nurse).

So we are going to get a CT scan to rule out an internal hernia — which is the next thing.  And is a possibility since I did some heavy lifting on Sunday (mulching the front yard).  If that comes up negative, then the doc gets to order a new toy (and he’s a bit gleeful about it — he has to show a need for it with two patients — I’m number two..)  This new toy actually allows him to scope the remnant stomach — so yay for technology.  So for now I’m off the Carafate (since it won’t do me any good anyway), with no changes in diet and just adding Prilosec in case there’s ulceration in the remnant stomach.

This also goes to show that the occasional caffeine, coffee, soda, RedBull, spicy food, etc. will not hurt your pouch.  I mean, c’mon!  I had coffee on Monday morning before my attack, and some on Saturday morning — and I’m pink as can be.  Just goes to prove that these things are not as horrible as they’ve been vilified to be.

Now if you’ll excuse me?  I think it’s time for a nap.

Flintstones and Tums aren’t enough postop.

Some of us know this already — but heya! there’s a study that gives some credence to what some of us have been saying.  There was an article published in The American Journal of Clinical Nutrition, the Official Journal of the American Society for Clinical Nutrition, Inc.

Nutritional deficiencies after Roux-en-Y gastric bypass for morbid obesity often cannot be prevented by standard multivitamin supplementation, by Christoph Gasteyger, Michel Suter, Rolf C Gaillard, and Vittorio Giusti.  (Article can be read here.)

Before you ask, the numbers are based off of an unknown, regular multivitamin.  The studies are not based off of a bariatric multivitamin, or using ASMBS recommendations.  However, this just proves why we should heed those recommendations.  Lots of numbers ahead – scary numbers, actually.


The study, in the end, included 137 morbidly obese patients (110 women and 27 men) — these were the ones who maintained the lab requirements, the supplementation requirements, the doctor visits, etc.  Initially, there were 348 patients in the study, but only about 33% complied with the postoperative care requirements, which, in of itself, is a sobering statistic.

Lab testing was done at 3, 6, 12, 18, and 24 months postoperatively.

This, folks, is where it gets really scary.

  • 3 months postop, 34% required at least one additional supplement to the multivite
  • 6 months postop, 59% required at least one additional supplement
  • 12 months postop, 86% required at least one additional supplement
  • 18 months postop, 93% required at least one additional supplement
  • 24 months postop, 98% required at least one additional supplement to the multivite
  • After 2 years, 2.2% took 0 additional supplements
  • 18.3% took 1 additional supplement
  • 19.7% took 2 additional supplements
  • 22.6% took 3 additional supplements
  • 27.7% took 4 additional supplements to the multivite
  • 6.6% took 5 additional supplements
  • 2.9% took 6 additional supplements
  • B12 was the most often supplemented — 10% were taking it at 3 months and 80% were taking it at 2 years
  • Iron was next — 15% at 3 months, and 60% at 2 years
  • Calcium +D — 17% at 3 months, 60% at 2 years
  • Folic Acid — 7% at 3 months, 45% at 2 years
  • B1 — 1% at 3 months, 4% at 2 years
  • B6 — 1% at 3 months, 13% at 2 years
  • Magnesium — 1% at 3 months, 13% at 2 years
  • Zinc — 1% at 3 months, 12% at 2 years

So what does all of this tell us?  Quite a bit.  First off..  33% of the people included in this study were able to pop a single pill, keep up with doctor appointments, get blood draws, add supplements as needed?  Only 33% could comply for a measly two years?  They got their insides sliced and diced, knowing this was going to be for life, knowing they would need vitamins for life, and they couldn’t maintain a simple protocol for a measly two years?  This frightens the heck out of me more than the numbers above do.  I mean.. what happens at year three?  Or, if they are still kicking, year ten?

But while we’re looking at the numbers, and let’s keep in mind that these are only for two years — and let’s not think about those of us kicking around the five year mark — that 98% of those in the study were at least on one additional supplement to a multivite.  That tells us that we need much, much more than the average bear.  So maybe, perhaps, the ASMBS has it right with their recommendations for doubling the multivite, adding some calcium, some iron, some b12, etc.?  That Flintstones and Tums aren’t going to cut it for long.

Yes, sobering statistics to be certain.