All posts in Post Operative Problems

Thiamine, Vitamin B1

Thiamine, Vitamin B1, is an important vitamin to be aware of. Although I don’t usually talk with my patients about this vitamin in terms of ongoing daily supplements, it does deserve some attention.

This vitamin is within the “B complex” family of vitamins and plays a part in sugar and protein breakdown. It is widely abundant in grains and meats, so healthy diets rarely put someone at risk of low levels. General multivitamins almost always have Vitamin B1 in the formulary.

This vitamin can be incredibly crucial when body stores are insufficient. You may have heard of medical terms like “Beriberi” or “Wernicke-Korsakoff Syndrome”, which describe specific symptoms of Thiamine deficiency. Basically, low levels of Thiamine can cause irreversible nerve injury. I have seen this before with traveling bariatric patients, and I can attest to the devastating consequences.

Not to scare you, but if you have chronic vomiting and you are not taking vitamin supplements, you are at high risk of developing Thiamine deficiency.

Low Thiamine can be easily reversed with many over-the-counter supplements. Like always, we will monitor your levels on a regular basis to ensure your safety. But remember your responsibility to maintain a healthy body through daily supplements recommended by our dieticians.

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Hair Loss

Hair Loss after weight loss surgery can be a big issue for some people. Most of my patients would rather not deal with any hair loss, whatsoever! There is a ton of information available about what is the best thing to do to prevent this, but unfortunately a lot of the literature is poor on scientific facts and liberal on anecdotal marketing! Here’s the facts:

  • Hair loss is a response to the stress on the body from a surgical procedure and significant weight loss
  • Hair loss is temporary, and usually is most prominent at 6 months after surgery
  • If hair loss is still present after one year, this is rare and can be associated with a nutritional deficiency
  • Supplements may help, but your body needs to go through its normal response to stress

If you want to take something to try and minimize hair loss, be aware that results are not proven with any product out there. We do know that Iron and Zinc and protein stores should be at their normal levels to minimize hair loss. Taking a multivitamin (and iron if you’ve had a Bypass) should be adequate. Biotin has been a popular supplement, but there is no proof of efficacy.

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Strictures

Strictures are a problem unique to the Bypass and Sleeve patients. Basically, it is a narrowing preventing food to pass normally through your digestive system. With the Bypass, strictures occur at the gastro-jejunal anastomosis (the top connection where the small bowel is attached to the gastric pouch). Sleeve patients can have a stricture anywhere along the length of the stapled stomach. A stricture will almost always occur within the first three months after surgery. Generally, a patient will complain of not being able to advance their diet beyond liquids. They may have frequent vomiting episodes, or even night time regurgitation/reflux.

A stricture can be identified by an Upper GI Swallow, but the most appropriate test is an EGD (v). An EGD is where the doctor gives you an IV sedation, and they pass a long flexible scope with a camera on the end, down the esophagus to evaluate the narrowing. If there is indeed a stricture, the doctor can usually dilate it with a balloon. Strictures commonly are fixed withEGD dilations, but sometimes a surgery is required for persistent symptoms. One of the new options for treatment include placement of a temporary stent via the endoscope.

What causes a stricture? We can’t always say with certainty why one individual ends up with a stricture. But factors that can create this problem include how the surgery was done and how the patient responds to healing/scarring. Strictures are rare, anywhere from 1 to 8% in the literature. A reasonable stricture rate for a surgeon should be 1-3%.

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