help with post bypass patient

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I am looking for some expert help here. We have a patient who is now 1 year post gastric bypass. She lost 150# in 13 months, now at a BMI of 22. She did not come for f/u with RD until her 9 month post-op. At that time it was apparent that she was eating much less than the average 9 month post-op. Thiamin, Vit B12 and folate deficiencies were identified and treatment started. She received IM/IV thiamin and B12, now both labs are wnl. First question....she complained of severe migraine type headaches with the injections of B12 and B1, anyone heard of this, know why it happened?

She has returned now complains of worsening neurologic problems, i.e. repeating herself, poor memory, sleep disturbances, weakness. So we checked Thiamin, B12, copper, zinc, magnesium, Vit D and folate again. Folate was low at 5.1; Mg was high at 2.4; Vit D low at 20 otherwise labs were normal. The NP that I work with was so sure that it was her thiamin and Wernickes was developing but her Thiamin level was well within normal limits and she had not had an injection in over a month. Obviously we will correct folate and Vit D issues but I do not think these are contributing to the symptoms......Anyone have any suggestions or ideas for me? All help is appreciated. last note her dietary intake has improved although she continues to lose weight so it is not yet to an appropriate calorie level. She has some pain and some vomiting with food and this limits her overall intake.

Laschkewitsch RD LDDietitian, Legacy Obesity Institute(503) 413-8135

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