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#3, gaining it all back. Sometimes, the person opted for the wrong surgery for themselves. Like getting a sleeve when they need a malabsorbtive procedure.
For a sleeve, the next obvious step is the Duodenal Switch because they keep their sleeve. They just add the malabsorption.
#2, except for using bariatric formulas of vitamins, you are dead on. I get my labs done yearly now but until I was 10 years out and stable, I was getting them down every 6 months. My PCP handled mine cause my surgeon was no longer accepting my insurance. And we had moved far away. And most bariatric surgeons do not accept other surgeons patients. I get about 15 vials done yearly looking at so many things, except for two lab values, everything else is high side of normal. B6 and PTH need to be low normal. But I get most of my vitamins are found on Amazon.
As far as fact #1, you are correct. That’s why we encourage preops to get labs before surgery so they can correct reall bad deficiencies if they have time, like D that’s in the toilet.
I agree, people often choose the wrong bariatric surgery, especially those with lap band. The complication rate is extreme and the total loss is low. Just not really worth it.
Most Bariatrics programs now go from VSG to RNY, as the data is showing better results vs VSG to DS. One of my cousins had RNY with a Fobi band placed- she lost nearly 300 pounds but has had many issues with the Fobi the last 12 years.
My preference is to use Bariatric Advantage vitamins. I started them pre-op, used them for 3-4 years, and then switched to "let me work on this myself" since the BA isn't cheap. I was taking far more pills throughout the day, basically, every 2 hours when I was awake. I switched back to BA after 6 months for the sake of simplicity.
I get bloods drawn quarterly, when I go for my iron infusion. The HemOnc runs full panels and shares with my Bariatric Surgeon with a ping in MyChart. I prefer my BS manage me in the way a primary would- and that's something he offers all his patients. It's been my experience, both as a patient and working for Internists, far too many aren't well versed on bariatric needs.
I agree, people often choose the wrong bariatric surgery, especially those with lap band. The complication rate is extreme and the total loss is low. Just not really worth it.
Most Bariatrics programs now go from VSG to RNY, as the data is showing better results vs VSG to DS. One of my cousins had RNY with a Fobi band placed- she lost nearly 300 pounds but has had many issues with the Fobi the last 12 years.
My preference is to use Bariatric Advantage vitamins. I started them pre-op, used them for 3-4 years, and then switched to "let me work on this myself" since the BA isn't cheap. I was taking far more pills throughout the day, basically, every 2 hours when I was awake. I switched back to BA after 6 months for the sake of simplicity.
I get bloods drawn quarterly, when I go for my iron infusion. The HemOnc runs full panels and shares with my Bariatric Surgeon with a ping in MyChart. I prefer my BS manage me in the way a primary would- and that's something he offers all his patients. It's been my experience, both as a patient and working for Internists, far too many aren't well versed on bariatric needs.
Many surgeons are now offering a third option know with ASMBS (the governing body) as SADI but surgeons call it SADI, SIPS, LoopDS, Modified DS with no general consensus of what it is. Right now there is no CPT code for any of them and many unethical surgeons tell their patients it’s “like” a DS. We’ve spent the last 10 years in the DS groups correcting misinformation, reading operative reports to end up telling unsuspecting patients that their doctor gave them a surgery they did not expect.
I take a handful of pills three times a day BASED ON MY LABS. Some do take vitamins and minerals more often. Their lab levels dictate that.
We actually prefer to deal with a young PCP or a PA, or NP willing and eager to learn. One curious and not stuck in the mud going “I’m the doctor with 6 years of med school” to which I usually respond, but I am the one LIVING this 24/7/365, have taught other doctors about my condition. You have other patients, I have just one, I can focus on my one disease.
Many surgeons are now offering a third option know with ASMBS (the governing body) as SADI but surgeons call it SADI, SIPS, LoopDS, Modified DS with no general consensus of what it is. Right now there is no CPT code for any of them and many unethical surgeons tell their patients it’s “like” a DS. We’ve spent the last 10 years in the DS groups correcting misinformation, reading operative reports to end up telling unsuspecting patients that their doctor gave them a surgery they did not expect.
I take a handful of pills three times a day BASED ON MY LABS. Some do take vitamins and minerals more often. Their lab levels dictate that.
We actually prefer to deal with a young PCP or a PA, or NP willing and eager to learn. One curious and not stuck in the mud going “I’m the doctor with 6 years of med school” to which I usually respond, but I am the one LIVING this 24/7/365, have taught other doctors about my condition. You have other patients, I have just one, I can focus on my one disease.
I always say, your own due diligence is a must with these surgeries. Honestly, my original program, I felt was pushing RNY and unfortunately, the nutrition program was so outside the ASMBS I was stunned. For example, I was told take on Flintstone vitamin a day. Um, that's not a complete vitamin for any adult never mind one with RNY.
I decided at that point to just follow ASMBS guidelines for RNY daily supplementation. I've never had issues with fluctuations, outside of iron, with Bariatric Advantage's RNY formulation. (once I brought everything up to where it should have been pre-op)
When I was doing it myself, it was, "Ok, 4 of these needed, spaced out, so 2x per day, and then 3 of these" etc. I just find it easier to manage not figuring it out on my own. :P Like my BS said, "Your numbers are fantastic, so keep on keeping on with what you're doing".
This is actually my second BS/program. He fixed up several major late complications I had, including a broken candy cane, necrotic intestines at the stoma, and my pouch literally sitting entirely inside my diaphragm. (There were others too, my liver fused to my abdominal wall by scar tissue, a perforated ulcer that was dripping acid onto my pancreas (thankfully I got to keep that during the 9 hour repair surgery)
All 3 of those major issues and the associated pain/complications- I complained about for 3 years to my original BS. She had every excuse in the book as to what was going on and never once ordered further diagnostic workup. I finally threw in the towel one day when I woke up with acid literally pouring out my nose as if I had turned on a faucet. The only thing she did for me was say my gallbladder was bad and took it out. 3 days later same pain, same symptoms and then let's start adding in reflux that was never an issue in my life.
I always say, your own due diligence is a must with these surgeries. Honestly, my original program, I felt was pushing RNY and unfortunately, the nutrition program was so outside the ASMBS I was stunned. For example, I was told take on Flintstone vitamin a day. Um, that's not a complete vitamin for any adult never mind one with RNY.
I decided at that point to just follow ASMBS guidelines for RNY daily supplementation. I've never had issues with fluctuations, outside of iron, with Bariatric Advantage's RNY formulation. (once I brought everything up to where it should have been pre-op)
When I was doing it myself, it was, "Ok, 4 of these needed, spaced out, so 2x per day, and then 3 of these" etc. I just find it easier to manage not figuring it out on my own. :P Like my BS said, "Your numbers are fantastic, so keep on keeping on with what you're doing".
This is actually my second BS/program. He fixed up several major late complications I had, including a broken candy cane, necrotic intestines at the stoma, and my pouch literally sitting entirely inside my diaphragm. (There were others too, my liver fused to my abdominal wall by scar tissue, a perforated ulcer that was dripping acid onto my pancreas (thankfully I got to keep that during the 9 hour repair surgery)
All 3 of those major issues and the associated pain/complications- I complained about for 3 years to my original BS. She had every excuse in the book as to what was going on and never once ordered further diagnostic workup. I finally threw in the towel one day when I woke up with acid literally pouring out my nose as if I had turned on a faucet. The only thing she did for me was say my gallbladder was bad and took it out. 3 days later same pain, same symptoms and then let's start adding in reflux that was never an issue in my life.
I fired my first surgeon. I went in KNOWING what I wanted as far as surgery type, I had done over six months of research and talked to people living with the surgery who were local. But the surgeon I got scheduled with had an artificial line in the sand for the surgery I wanted even tho my insurance okayed it. This was before the sleeve was an option with Medicare. My options were Lab Band, oh hell no, RNY, I required NSAIDS, and DS. He said I was too small for the DS even tho Medicare did not. I mentioned my requirement for NSAIDs, he said just take opioids. I fired him.
Then I went on a hunt for a surgeon who would do the DS on me. I found one, but in NYC. My version of Medicare said stay in TN. I contacted every surgical office asking three questions. Did they accept Medicare, did they do the DS, and did they do the DS on lightweights. Mostly I got no by the time I got to question number 2.
Finally found one but he was the partner of asshat, who had to release me as a patient. Thankfully he did and I got my DS.
Recently my GERD acted up, it had been easily controlled by a PPI, but not in the last two years. My gastroenterologist found a hiatal hernia. Kept being told to change to a RNY to cure the reflux. Well, I know several RNYers who have GERD post op. So it’s not a cure. And it didn’t address the hernia. I fought too long for my DS, I wasn’t going down without a fight. Found a local BS (we had moved over 600 miles from my original surgeon) willing to take me on as a patient who did the DS. He fixed me and SAVED my DS.
I understand the frustration of knowing something is wrong and not getting proper help.
I had the gastric sleeve 07/05/22 so this week I hit one head out. There were bumps along the road the highway one was that a lot of food gave me a hard time for a long time (but I’ve always had a very temperamental stomach) I stopped my reflux meds around 6 months as advised but went back on them around 9 months and things have been great since
I ended up dehydrated 3x in the year
But I’m down 146 pounds from my heaviest and 102 from the day of surgery. I started playing softball again and regularly go to yoga.
I went from a size 22 to a size 0/2 and a 3x to an xs/s
Thank you I will try it. Sorry I took so long to get back to you.
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Sorry I took so long to get back to you.
