Re: post-op complications! The LIST LOL

April 10, 2001

In a message dated 4/10/01 2:30:38 AM, duodenalswitch writes:

<< If you don't mind me asking just a couple more things, I happened to

notice that you mentioned that at Mt. Sinai, they gave you cards about the

possible post-op complications, well I was wondering if you wouldn't mind

explaining some of the more serious things, and how they can be prevented, or

what the percentage is for the risk?? I am sure that there are others who

would be interested in knowing this to help aide in the decision of surgery.

Or if there is a site that gives out accurate information to which you or

someone might refer us pre-ops?>>>>

Hi, karen from PA: these are the things that are mentioned on our BPD/DS

'emergency' cards (To be referred to by emergency medical staff or regular

doctor, etc. in case we present at a hospital/office with problems). The

only thing I find confusing about it is that some of the symptoms really do

seem to apply to RNY patients, not BPD/DS. It's as if the Mt. Sinai staff

made one 'all purpose' card and then put different labels on it:

1. GASTRIC POUCH OBSTRUCTION: May occur due to anastomitic stenosis,

food impaction or ulceration. (*******I THINK THIS IS A DEFINATE POSSIBILITY

FOR RNY PATIENTS, I WAS SURPRISED THAT IT IS A POSSIBILITY... THEY CONSIDER

OUR SLEEVE GASTRECTOMY A '100 CM POUCH'... I GUESS IT IS POSSIBLE, BUT I'VE

NEVER HEARD OF IT HAPPENING WITH A BPD/DS AND IT'S PROBABLY QUITE RARE?)

2. DEHYDRATION: may occur due to limited po intake (this is a possibility

with a BPD patient, too I guess)

3. SMALL BOWEL OBSTRUCTION: due to adhesions or internal herniation. A

definite possibility for us.

4. VITAMIN DEFICIENCY: Including B1 (Wernicke's encephalopathy), B12,

folate and especially fat-soluable A, D, E, and K. (WE ABSORB B-1 AND B-12,

SO I THINK THE FOLATE AND FAT SOLUABLES ARE OUR MAIN PROBLEM)

5. MINERAL DEFICIENCY: especially calcium, magnesium and iron is not

uncommon.

6. SEVERE PROTEIN DEFICIENCY: (Kwashiorkor) may require intravenous

nutrition (this is a DEFINITE possibility if one does not eat sufficient

protein, but it takes time to develop) (see LIVER PROBLEMS BELOW!).

To this list, I would add: general HERNIATION --- which may not cause bowel

obstruction but require surgery nonetheless or interfere with a major blood

vessel, etc.

Having done quite a bit of pre-op research on GASTRIC AND PANCREATIC CANCER,

there doesn't seem to be any increased risk of pancreatic cancer (that holds

for those who have had a gastrectomy which removes the lower part of the

stomach and pylorus -- a BPD patient *may* have increased risk, but not a

DS).

However, the stats are a less clear on gastric cancer. One of the risk

factors is gastric surgery (of any type, they didn't really specify). I

think, though, that they are always referring to the artificial introduction

of the intestines into the stomach wall (although the type of connection made

in an RNY has NEVER been shown to cause cancer, etc. and is NOT the same

connection made in the mini gastric bypass).... our anatomy is NOT radically

altered like that. Our stomachs are merely (?!!) reduced. So, if gastric

cancer risk is increased by any kind of stomach-intestinal connection/stoma

(i.e. - it allows gastric acid to pop back into the stomach and immediate

intestine to which it is attached, thus potentially stimulating irregular

cell growth, from what I understand), then we wouldn't be at risk. If there

is risk associated with developing scar tissue/trauma from surgery, then we

would be at some risk.

Eating acidic/preserved/pickled foods, etc. can also contribute. I'm sure

it's a complex combo of factors and just having gastric surgery DOES NOT mean

one will get gastric cancer. The good news is any research done on WLS

(either RNY or DS) has NOT shown any remarkable rate (or any instances, I

think?) of gastric cancer post-op. If there was a clear connection based on

having the surgery alone, I know that this would appear clearly post-op and

would be a high risk factor.

Now, there is much debate over a certain stomach-intestine connection used in

the 'mini gastric bypass' ---- the biliroth II, I think. It HAS been shown

to specifically cause a higher risk of gastric cancer (to everyone but the

surgeon performing this surgery, it seems).

Even though the RNY has never been proven to have severe problems, I don't

like the idea of having that kind of connection between my stomach and

intestines.... I'd much rather keep the pylorus and have the stomach shaped

as naturally as possible post-op.

I've also heard some mention KIDNEY STONES/KIDNEY PROBLEMS. I think this is

rare, but always within the realm of possibility. I'll let someone more

medically proficient address this, but I think it has something to do with

calcium intake? It's always a GOOD IDEA to keep well hydrated and drink lots

of WATER post-op to keep the body flushed out.

Another possibility is LIVER PROBLEMS --- but NOT caused by the surgery

itself (as with the previous jueunial bypass -- didn't spell it right). The

BPD/DS has not been shown to put any extra strain on the liver (other than

the effects of rapid weight loss, which in general can elevate liver enzymes

temporarily). HOWEVER, if one does not get adequate protein, the liver CAN

be affected. I guess this isn't a separate complication, but instead really

falls under severe protein deficiency.

Other lesser complications can occur like LACTOSE INTOLERANCE/GLUTTON

INTOLERANCE. Although these aren't life threatening, they can be very

dehabilitating and frustrating until one finds a solution (often through

trial and error).

There can be other minor complications like: HAIR LOSS(usually temporary and

a result of the rapid weight loss not the surgery per se), DRY SKIN (which

may be a good thing if one was particularly oily pre-op LOL), GAS/DIAHREA

(to varying degrees), FOOD INTOLERANCE (once again, usually temporary and

happens within the first 6 months to a year post-op), NAUSEA (usually within

the first 6 months post-op), VOMITING (from eating too much and adjusting to

the new stomach size, but can ALSO be a symptom of blockage if the person

hasn't been overeating), TOTAL LOSS OF APPETITE, DEPRESSION, EXHAUSTION (to

varying levels). I've heard of some people PASSING OUT/BECOMING LIGHTHEADED

because their hearts are unable to accomodate the rapid weight loss (this is

usually true for those with a higher bmi and usually not severe or an

indication of heart problems, etc.). One can also become lightheaded, etc.

if not properly hydrated! Deyhdration is one of our biggest enemies!

I can't really think of other possible late-term complications.... But,

someone else may be able to add something else.

<<<<

>>>>

Well, it really depends on what you mean by 'average'. LOL There is a huge

debate going on about calcium. We are at theoretical risk for developing a

calcium deficiency because most of our intestines cannot absorb it (only 5

cm, whereas an RNY post-op has none). But, osterporosis depends on genetic

predisposition, the state of health/density of bones pre-op, etc... it isn't

just a factor of not getting as much calcium post-op. We are urged to take

that much calcium as a precaution, but there haven't really been any long

term, comprehensive studies done.

Same holds true for other supplements. Our bodies change over time --- and

change in response to activity level, age, hormones, etc. Our

supplementation needs may also change. Sure, if we take our supplements as

told, we shouldn't encounter severe deficiencies, especially if the

supplementation levels are adjusted according to our labwork. To me, the

challenge really comes after one year post-op. I think the surgeons really

monitor us well up to one year. Then, it is every year. Now, a lot can

happen in a year. I'm going to my PCP every 3 months after the year just to

be on the safe side. I've heard others say that every 6 months is as

acceptable. We can have great labs one year and then be confident and have

some deficiency already in progress the next.

Our health also depends largely on what we eat. The supplements are meant to

supplement our eating -- I mean, if for some reason we aren't eating as well

as before but still taking supplements, this may affect us inadvertently down

the road sometime. Overall, the medical community agrees that getting

nutrition from actual foodsources is the best way to ensure complete

coverage. The supplements are there to cover all bases since we obviously

can't eat enough excess to overcompensate for our malapsorbtion. Not ALL

trace minerals, essential vitamins, etc. can be found in adequate percentages

in supplementations alone. Our activity level, amount of exercise,

genetic predisposition, etc. -- all come into play.

So, yes -- our supplementation will help us stay well. BUT, we must also get

periodic aftercare and blood checks to ensure that the supplementation is

still efficient and suitable. We must also watch what we eat, focusing on

proteins, etc. -- in order to stay in maximum health long term, IMHO.

What if we get pregnant (for women)? Or sick? What if we (God forbid)

developed cancer? Required other medicines? How would they be absorbed?

How would our inability to eat as previous affect our overall nutrition?

Once again, we require frequent medical attention throughout or lives to

appropriately adjust our supplementation levels to meet these new challenges.

Even greatly increasing our activity level can necessitate more protein or

more vitamins. As time goes on, our bodies will adjust better and adapt to

the new arrangement (our common channels have shown that they can lengthen,

our cell walls/receptors within the common channel can thicken, etc. to

maximize absorption). Perhaps at a later date we may need LESS of a certain

supplementation!

This is why it is ALWAYS a good idea to stay well hydrated and drink lots of

WATER. If one's body doesn't need some of the supplementation, the kidneys

work extra hard to try to process it/get rid of it (I'm not sure what

vitamins/minerals this applies to -- I know that some will pass through the

body without any harm other than loose bowels -- like vitamin C, while others

CAN cause potential damage).

<<<<

>>>>>

No problem! Hope I can be of help. I don't know of any sites other than the

duodenalswitch. com site and the studies there... I'm sure there are other

sites, but other people would be able to refer them.

I was a research fiend and really, really wanted all the information possible

before making this decision. I don't regret it one bit! This operation

really saved my life and helped me get it back. I think that those who

choose the BPD/DS in general are pretty well educated about things because

they have to fight to get information (it just isn't readily available among

the medical community, etc. and is a much lesser publisized operation).

I wish you the best on your journey!

all the best,

laparoscopic BPD/DS with gallbladder removal

Dr. Gagner/Dr. Quinn assisting/Mt. Sinai/NYC

January 25, 2001

77 days post-op and still feelin' fab!

pre-op: 307 lbs/bmi 45 (5'9 " )

now: 269 (lost the .05! LOL)/bmi 40

April 10, 2001