Message from Venice

After arriving in Pisa, Italy we met our American friend, Jessica, who lives in Pisa. We had a great day reconnecting and walking through the countryside with Jessica. Dinner that night at one of her favorite restaurants topped off a wonderful day.

Yesterday we traveled by train and arrived in Venice in the afternoon. Although we lived in Italy for a couple of years many years ago, this is our first visit to this amazing city. We were on a student’s salary when I studied in Italy and could not afford the train ticket to Venuce back then. Just walking through the narrow streets to S. Marco’s Cathedral and enjoying the sights and sounds makes my shoulders drop and helps me remember how much I love this country and it’s people. We have forgotten more of the language than we remember but it is wonderful to speak Italian again even if embarrassingly little.

Dinner with my stunning wife, Beth, at a restaurant in St. Marco’s square with the music from the orchestra playing nearby was a wonderful celebration of our 36 years together. It is an honor to be loved and carted for by such an amazing woman. Sleep was not easy with the sounds of the boats motoring along the Grand Canal under our window. The boisterous passersby did not help but certainly added to the ambience.

Well, we have finished breakfast and it is on to exploring the city. Our gondola should be waiting! I will post again when I have the time.

I am convinced our second honeymoon is even better than the first. The picture is of the hospital in Venice!

Dr. Myers Returns to Italy

Ciao! From Italy. Returning to Italy is another grand adventure for us. Thirty six years ago my wife, Beth, and I traveled to Italy. We had been married only six months and at 21 years old neither of us knew just what we were in for. All we really knew was we were off to Perugia, Italy to learn Italian before I was to start medical school in that country. We were courageous, confident and much more naïve than either of us realized. Why not start medical school like a normal person in the US, my native land you ask?

Although I grew up in Ohio, I had gone out of state to the college of my choice in Springfield, Missouri and completed my bachelors degree at Evangel College in three years. Going to this college was one of the best decisions I ever made because I met the love of my life and she agreed to marry me, We had returned to Ohio where I had been a PhD candidate at Ohio State University in Physiological Chemistry but what I really wanted to do is to go to medical school to become a doctor. At that time there were too many of ” baby boomers” like me trying to go to medical school and not enough positions available. In fact I noticed that nearly everyone else in my PhD program also wanted to go the medical school and were not getting in!

Beth found out I could start medical school in Europe and we selected Italy. We proceeded to Perugia, Italy to begin language school I told myself “How hard could it be to learn Italian? Even little children learned Italian and since I survived organic chemistry I should be able to learn a new language”. Oh boy! What I should have known is that the skill set needed to learn a language is very different than the skill set necessary to learn the sciences. Sometimes ignorance is bliss. Beth passed her language exam and I received a certificate of attendance!

Still I was able to begin medical school at the University of Genoa, Genoa, Italy in the fall despite my language challenge. Of course all the courses were in Italian and the exams were oral exams. This was indeed a challenge but I still did well. After completing the first 2 years in Italy I took the board exam in the US and was able to transfer to the University of Cincinnati for my last 2 years of medical school. I was privileged to be elected into the medical honor society and gradusted with my MD fron the U of Cincinnati in 1980.

Now as I sit on this Delta flight next to my precious bride of 36 years to return to Italy I have much to reflect on and much to be thankful for. Beth says the first week of this vacation is a second honeymoon to enjoy together before our adult children and grandchildren will arrive. This is a trip of a lifetime. The first week we will travel to Venice and on to visit some Italian friends from many years ago who now live in the mountains of northern Italy. After we meet the rest of our family a week later we will be taking over and possibly overwhelming a bed and breakfast in a vineyard 20 minutes outside of Florence. It should be fun and more than a little crazy with 11 of us. Like my 3 year old granddaughter Maddie would say ,” Granpa Steve, that’s im-pwessive. Get ready Maddie, there is much to be impressed about in Italy and it might be a little crazy too!

Also Ask About the Quality of the Program...

In addition to checking out the surgeon to see if he or she is the right one for you like I described in the last posting, spend time evaluating the quality of the program. This can make all the difference in the world in your long term result. For instance our patients lose nearly 20% extra weight after surgery and I am convinced it is because our patients are truly ready for surgery and they receive all the tools necessary for them to get their best result and keep their weight off long term. This is the program that has been built around the operation to meet our patient's needs. Therefore you should ask about program details.

I am convinced that the better the quality of the program the better the results. Ask whether they have the following:

Do they have their own "in house" dietitians doing dietary consultations? How many and by whom. I believe there should be at least 3 before surgery and 3 after surgery by a Registered Dietitian)
Do they have their own “in house” psychologist? Does the program take seriously the psychological readiness of the patient to have surgery and do they have their own psychologist that specializes in bariatric surgery patients?
Do they have their own dedicated internal medicine specialist? A thorough and comprehensive medical evaluation is important to assess your risks and make changes to decrease your risks during surgery.
Do they incorporate a postoperative exercise therapy program after surgery with a exercise therapist to help you return to tour best activity level.
Do they help you with obtaining approval from your insurance company and take the hassle of getting approval as quickly as possible.
Do they expect to continue to follow you medically for the rest of your life to make sure you do not develop vitamin or mineral deficiencies and to help you obtain your very best long term result?
Do they have professionally directed support groups? The groups should be facilitated by a dietitian, Psychologist, or nurse to keep the comments positive and helpful for the entire group.

If the program you select is doing all of this I believe that will translate into a better result for you and you are much more likely to have all of the tools you need to keep your weight off long term and live a healthier and hopefully longer life.

Remember, this is your one time to have bariatric surgery. You want all the help ypou can get to do the best you can. Do not go "cheap". Find the best surgeon and the best program you can find. It"s your life. You deserve the best so investigate both the surgeon and the program thoroughly.

New Article Can Help You Chose the Bariatric Surgeon that is Right for You

In a recent article, Relationship between surgeon volume and adverse outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery, by Mark Smith et al, in the March/April edition of Surgery for Obesity and related Diseases, the official journal of the American Society for Metabolic and Bariatric Surgeons showed that the frequency of serious complications decreases as the annual number of Roux en-Y Gastric Bypass operations performed by a bariatric surgeon increases.

In other words a bariatric surgeon that does a large number of gastric bypass operations, (100-150), each year is likely to have less adverse outcomes such as 1) blood clots formed in the legs. 2) blood clots that leave the legs and pelvis and go to the lungs, 3) need for reoperation, 4). delayed time in the hospital of 30 days and 5) death.

This was true for patients at high levels of risk, medium levels of risk and even patients at low levels of risk as determined before surgery.

Although this study was evaluating patients having a gastric bypass I suspect it is probably true regardless of which operation you chose.

How might this information be important to you? Patients considering bariatric surgery should investigate how often a surgeon performs a specific bariatric operation before deciding which surgeon to choose to do the operation. I also believe it is important to investigate what are the outcomes that patients have after being operated on at a particular program as well as by a particular surgeon.

Your questions should include:

How many of these operations did you perform last year?, (it is best if the number exceeds 100 for gastric bypass)

Where can I find the answers to the following questions if a form that is available to the public?

What is the average loss of excess weight at 1 year for patients you have performed this operation on? (the average is 62% at 1 year for gastric bypass and probably about the same for a gastric sleeve, the average is 48% at 3 years for gastric band patients. Some programs reach about 80% excess weight loss for each of these categories if they have a very robust program to help you get your best result like the Fresh Start Bariatrics program)

How frequently have your patients had the following problems after surgery:

Blood clots in the legs, (should be much less than 1 in 100)
Blood clots to the lungs, (should be much less than 1 in 100)
Leak from a staple line, (should be less than 2 in 100)
How often do you need to return someone to the operating room, (should be less than 2 in 100)

How many patients have died after a bariatric operation that you have performed? How many in the last 500 operations?, (should be 1 or less but remember the number may not be zero since some of the patients are high risk because of severe medical problems and may not survive much longer with out surgery)

These questions will help to guide you so you will make a wise choice for your surgeon.

I believe the quality of the overall program is also very important and I will discuss this in this blog tomorrow.

To keep weight off long term after surgery, try Dr. Myers "RULE OF 30's"

Would you like a suggestion to help you maintain your weight after bariatric surgery? Most bariatric surgery patients certainly would.

In addition to the suggestion to eat solid food and avoid drinking high calorie liquids such as milk, fruit juices, cream soups and ice cream add the following to your meal routine:

APPLY DR. MYERS’ RULE of 30’s TO YOUR EATING HABITS!

1). Chew all non-liquid food 30 times before swallowing. This will slow your eating down to the correct speed and you are likely to eat less calories with each meal.

2). Swallow your food once every 30 seconds. It takes about 30 seconds for food that is swallowed to travel all of the way down your esophagus to reach your stomach. Eating more frequently than every 30 seconds means you are not waiting long enough to allow the signals from your stomach to reach your brain and you are stacking food in your esophagus. It’s the food equivalent to traveling too close to the car in front of you in bumper to bumper traffic. It does not give you enough reaction time to stop in time before you crash! Give yourself a “safe clear distance” and avoid the problem that comes with eating too close together.

3). Wait 30 minutes after a meal before you drink your non-calorie containing liquids. This will give the solid food more time to leave your gastric pouch or sleeve and you are likely to have more room for the protein you need.

If you need some encouragement and a new technique try applying the RULE OF 30’S. I want everyone that has bariatric surgery to be successful and this technique may help you stay on track.

New Video - Chris' changed life!

Chris explains how his life has changed since bariatric surgery!

Dr. Myers, How do you suggest my rheumatoid arthritis medicines be changed around the time of my bariatric operation?

This was a question raised by a woman at the bariatric surgery informational seminar I spoke at today. She has had rheumatoid arthritis for several years and is on methotrexate, an immunosuppressant, and treats flare ups with prednisone. All of these medicines suppress inflammatory activity to keep her rheumatoid arthritis under control but for the same reason they will make healing more difficult.

The overall goal is to allow her to heal normally around the time of her operation but to resume her medications as soon as possible after adequate healing is obtained. We therefore want to stop any medicines that will interfere with wound healing at the right time so the negative effect of the medicines are suspended for about three weeks after her operation since about 80% of healing is completed by three weeks after an operation.

For instance: she takes methotrexate once a week. I would suggest that she take her last dose 2 weeks before surgery so it will be out of her system when she has her operation. She could then resume her methotrexate 3 weeks after her operation.
Similarly for her immunosuppressant, she should discontinue this medication so it’s effect is gone when she has surgery and it could be resumed after 3 weeks of healing assuming she has no infections and all is going well.

I would prefer that she reduce her prednisone to 7.5 mg per day or less but we could use higher doses of steroids in she had a flare up while off of her medications.
To control her joint pain while off of her other medicines we will need to use narcotics such as Percocet and/or she may need to be on a Fentanyl patch for a few weeks.

In this way we should be able to reach the goals of appropriate healing and manage her joint pain. This may sound complicated but it is not an uncommon scenario and patients do well with this approach.

Innovation in surgery keeps life exciting for Dr. Myers

I am sitting in the Reagan National Airport before leaving Washington, DC to return home to Columbus, Ohio after attending the 12th World Conference for Endoscopic Surgery.

As I reflect on my 25 years as a surgeon it is amazing to me how much the techniques of surgery have changed. The principles of tissue healing and infection control still are basically the same but how we do what we do is very different.

When I completed my surgery residency in 1985 nearly all operations were done through large incisions in the abdomen. The only laparoscopic operations were tubal ligations and viewing the pelvic organs. In 1989 a major revolution began to occur as surgeons began to use the laparoscope to do abdominal operations. First I learned to perform gallbladder operations laparoscopically then I, as well as many other general surgeons, learned to do other operations using minimally invasive techniques such as groin hernias, abdominal wall hernias, colon operations and stomach and small bowel operations.

Nearly 7 years ago I began to do bariatric operations and as I began I applied the laparoscopic approach pioneered by Dr.Allen Whitgrove from San Diego who reported the first in human laparoscopic Roux en-Y gastric bypass in 1995.
Now, although I restrict my practice primarily to bariatric surgery, even complicated revisions and bowel resections and other complicated operations are done with minimally invasive techniques. Today I can go months without doing an operation through a larger incision.

There are other skills we are acquiring as well to enhance the practice of surgery. For instance yesterday I learned to do video editing so I will be able to present digital videos of procedures to my patients, to other surgeons and to the public. Since nearly every operation I do is projected in High Definition on several TV screens in the operating room, it is a simple matter to record this digital information to be edited for later use. I would never have thought this would be an important part of a surgeon’s life but it is beginning to be so just like using the internet to communicate in forms such as this blog.

Today I spent the morning practicing on a new edition of the Da Vinci Surgical Robot. The new edition is very interesting and may bring additional value for our patients in less pain and quicker recovery. It may also be less wear and tear on their surgeon!

These 25 years have been an exciting ride with new innovations nearly every year and it continues even to this very day.

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News Release

NEWS RELEASE, April 15, 2010, Washington, DC


-Obesity Surgery performed through the vagina-

A first in human trail was reported at the 12th World Conference for Endoscopic Surgery in Washington, DC showing Obesity Surgery can be performed by passing some of the instruments through the vagina. This feasibility study reported on four patients who had a bariatric operation called a gastric sleeve procedure performed by passing a flexible scope through a small hidden incision in the vagina to visualize the structures inside the abdomen during the course of the operation. This procedure results in a 90% reduction in the size of the stomach. The redundant portion of the stomach was removed by the scope through the same small opening in the vagina. The four operations were possible in part by the use of a new supporting device called the Flexible Steerable Trocar make by Ethicon Endo-surgery. According to Dr. Stephan Myers, the Director of Bariatric Surgery at Riverside Methodist Hospital in Columbus, Ohio and the principle investigator and surgeon for this study, “This is a combined natural orifice and laparoscopic approach using the trans-vaginal approach for visualization and removal of the stomach with three small incisions in the abdomen to place additional instruments needed to perform the operation. Although one of the patients required a revision because the “sleeve” was too narrow, all four patients are doing well and are losing weight on schedule”. According to Dr. Myers we can expect to see more natural orifice approaches to obesity surgery in the future.


For further information contact:


Steve Myers, MD, FACS
drstevemyers@gmail.com
freshstartbariatrics.com
Mobile 614-557-8125

News from a Surgeon's Conference in Washington, DC

This week I am at the SAGES, (Society of Gastrointestinal Endoscopic Surgeons), here in Washington, DC. Many bariatric surgeons belong to this organization. I took two bariatric surgery courses today. It is always instructive to hear the point-counterpoint arguments between many of the various speakers. There has not been any earth shattering items but the following are some of my conclusions:

1). The Roux en-Y Gastric Bypass is still the operation all others are compared to.

2). The Gastric Sleeve Operation is gaining momentum as a frequently chosen operation but in many parts of the country insurance companies are still not approving it.

3). The Adjustable Gastric Band is still a popular choice but there are increasing concerns about how ofter the band needs to be removed or revised.In some areas of Europe where band operations have been done for much longer than in the US the band is very infrequently done and the sleeve is much more frequently performed. The optimal result with the adjustable gastric band is most strongly related to the frequency and quality of the followup.

3). The Duodenal Switch or Bileo-pancreatic Bypass is being performed by only a few surgeons attending this meeting.

4). Single incision surgery is being performed by a few bariatric surgeons but most are concerned it could bring more risk and may not provide additional value to our patients.

5). Best revision for those that do not do well with a gastric band is probably a conversion to a gastric bypass.

6). Best revision for a person who has not done well with a gastric bypass is probably a "adjustable gastric band over bypass"

7). For those people who have not done well after a gastric bypass,(5-15% of patients), endoscopic suturing without operation to cause narrowing of the outlet of the gastric pouch has not been shown to be helpful long term. Injection of a material,(called sodium moruate), that causes scarring and narrowing may hold some promise in narrowing the outlet of the gastric pouch appears to have some short term benefit but the long term results are still not available.

All of these items are consistent with my understanding even prior to this conference but I will "keep you posted".

Tomorrow I will present my research and I will explain that to you tomorrow.

More on the Possible Need for Plastic Surgery After Bariatric Surgery

Often I am asked if people that have bariatric surgery will need skin removed after they have lost weight from their operation. Often this is not necessary since the skin is flexible and can go back into a cosmetically pleasing contour. However, sometimes the excess skin is bothersome. This is most frequent in older patients, those that have been smokers since they have lost some of the flexibility of their skin. Also patients that are heavier than our average patients are more likely to need the help of a plastic surgeon.

If you have skinfold irritation I suggest you take pictures of the irritated skin and keep the photos for your plastic surgeon. This may help the plastic surgeon to get your insurance company to pay for the operation since the condition may be considered a medical condition and the operation may be considered medically necessary.

To care for these irritated skin folds prior to plastic surgery I would suggest using and anti-fungal powder such as nystatin powder for a week or so then change to Zeasorb which is an over-the-counter powder that is made from seaweed and absorbs body moisture well and should keep the skin healthy.

However, sometimes it is best to have the offending excess skin removed. Here is what one of the plastic surgeons at Riverside Methodist Hospital in Columbus, Ohio, Dr. John Waklin, wrote to help you to better understand the most frequently performed plastic surgery operation chosen by bariatric surgery patients:

“Abdominoplasty is the most common body contouring surgery performed for patients after they have losta large amount of weight. Variations of this surgery include a tummy tuck, a panniculectomy, and a circumferential body lift. Abdominoplasty surgery removes excess skin and fat from the abdomen that has become troublesome for patients. The skin and fatty tissue that hangs down is removed and the skin from the upper abdomen is stretched down toward the pubis to make the skin smooth. Often this requires that the belly button be repositioned back to its normal location on the abdomen.

Before surgery fitting this excess tissue into clothing can be uncomfortable, keeping areas underneath the skin folds formed by this tissue dry and free of rashes becomes an ongoing problem, and sometimes keeping the areas underneath this tissue from becoming infected can be difficult for many patients.

This surgery is done under general anesthetic (completely asleep) and can often be performed with other operations at the same time. This allows patients to recover from multiple procedures at once with the benefit of only needing to go under anesthesia once. In some cases, multiple body contouring operations can be performed along with an abdominoplasty procedure. Very often this procedure can be done on an outpatient basis, allowing the patient to recover in the comfort of his or her own home without the added cost of hospitalization.

Some insurance companies will cover the costs of an abdominoplasty procedure. This is highly dependent upon the patient’s symptoms, the insurance company, and the specific insurance plan. Your Plastic Surgeon can usually help guide you through this process.“

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Aetna Changes It's Policy and Now Covers the Gastric Sleeve Operation!

Today I was informed of the following:


As of April 9, 2010, Aetna has changed its position on reimbursement for sleeve gastrectomy, and will now cover the procedure. This coverage will be the same as the other bariatric surgery procedures covered by Aetna.

Per the official Aetna coverage policy, “Aetna considers open or laparoscopic Roux-en-Y gastric bypass (RYGB), open or laparoscopic sleeve gastrectomy, open or laparoscopic biliopancreatic diversion (BPD) with or without duodenal switch (DS), or laparoscopic adjustable silicone gastric banding (LASGB) medically necessary when the selection criteria are met.” (Selection Criteria detailed in the policy -0157).

This policy has the potential to impact over 18 million lives covered by Aetna.


This means Aetna now joins several other medical insurance companies in the Ohio area including Medical Mutual, United Health Care and Humana,(through OhioHealth),that cover the gastric sleeve procedure.

This is great news since the gastric sleeve procedure is increasingly the operation preferred by many people that come to Fresh Start Bariatrics at Riverside to have their bariatric operation.

I have performed over 100 gastric sleeve operations over the last two and a half years and have found that this operation is comparable to a gastric bypass operation in the amount of weight a person looses in the first year after their batiatric operation.

Although I believe a Roux en-Y gastric bypass is still the best option for most patients with type II diabetes and severe gastroesophageal reflux, other patients may do well to choose a gastric sleeve operation since there is less concern about mineral and vitamin deficiencies.

Hopefully in the near future all insurance companies will include coverage for the gastric sleeve procedure.

Please see the video posting I did on this blog to better understand how the gastric sleeve procedure works.
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Are people right when they say, "You are just taking the easy way out" when I tell them I am planning to have bariatric surgery?

I have often heard my patients explain that when they share that they are planning to have bariatric surgery with a friend or family member they are told, “you are just taking the easy way out”.

I tell my patients that anyone who makes a statement like this clearly does not know what they are talking about.

• There is nothing easy about complying with all of the requirements from your insurance company
• There is nothing easy about completing all of the preoperative workup and consultations to prepare for surgery
• There is nothing easy about recovering from any surgery let alone a life changing operation like bariatric surgery
• There is nothing easy about getting your mind around the changes that need to be made to be successful after bariatric surgery.

Taking the easy way out? I say, “NO WAY!”

My patients who have had bariatric surgery believe bariatric surgery is a reliable way out of a very difficult situation. And I agree. Since a person of size that meets criteria for bariatric surgery has less than a 5% chance of losing significant amount of weight and keeping it off long term with diet, exercise and behavior modification, bariatric surgery is clearly the best option for a person of size to resolve their obesity and keep the weight off.

Said another way, 95% of patients that meet criteria for bariatric surgery that choose to lose weight without bariatric surgery will regain the weight lost within 2 years of the weight loss. Everyone can lose weight. We all know that. The problem is keeping the weight off. Nearly every patient that has come to me for bariatric surgery has been through 10 to 20 weight loss programs and have lost significant 60, 80 or even 100 lbs temporarily only to have gained their weight back and more!

This yo-yo effect of weight loss is very discouraging and people feel that nothing is going to work for them since nothing has been effective long term in the past. Frankly many of my patients feel like a failure and they feel there is no way out. They are even afraid that they will be the one person that surgery will not work for.

It is truly a privilege to share with them that there is hope for them.

In fact about 85% of people that have bariatric surgery are successful long term. In our program the rate of long term success is much better than the average since Fresh Start Bariatrics has a very robust program and our patients are well prepared even before they have bariatric surgery. I do not say this to brag but to share with you that there really is hope for those who chose bariatric surgery.

Is bariatric surgery “the easy way out”? There is nothing easy about bariatric surgery for any bariatric surgery patient but it is a reliable way for people of size to lose most or even all of their excess weight, resolve, improve or prevent many obesity related medical problems and to begin life again without the suffering and despair caused by obesity.

There is hope for those that choose bariatric surgery so do not listen to people that know so little about the subject that they tell you that you are “just taking the easy way out”. They clearly do not know what they are talking about and are not worthy to advise you and are not likely to support you in your quest toward better health.

Take heart. There really is hope for persons of size.

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Video about Gastric Bypass Explained

Video of Gastric Sleeve Explained

New Video Post - Alcohol and Bariatric Surgery

"Band over Bypass" a Viable Option for People Struggling after a Gastric Bypass.

In a recent issue of Surgery for Obesity and Related Diseases (Jan-Feb 2010) Marc Bessler, MD from Columbia University in New York reported on his group’s experience of placing an adjustable gastric band over the gastric pouch from a previous gastric bypass.

In this article Dr. Bessler said, “We report on 22 patients who presented with inadequate weight loss or significant weight regain after proximal gastric bypass. All patients underwent revision with the placement of an adjustable silastic gastric band around the proximal gastric pouch.”

The results showed a 47.3% loss of excess weight at 2 years and if you compared their weight with the weight they had before either operation they lost a total of 59.4%

My experience is that most patients that see me in consultation who have not done well after a gastric bypass operation have fallen into one or more of the following situations:

1). They have gone to a location where the program is not very robust and has not helped them to get their best result.
2). They were not well prepared for their operation psychologically and/or nutritionally.
3). They were operated on with a very high BMI and did not lose weight before the operation to reach a BMI of 55 where they are more likely to have a better long term result.

Although it is unfortunate that these patients did not do as well as expected with their gastric bypass operation, the technique of “band over bypass” appears to be the best option at this time.

Other revisions such as changing the length of the small intestine, reduction of the size of the gastric pouch or decrease in the size outlet of the gastric pouch, (call the stoma), with the use of an endoscope have not shown to benefit patients significantly long term.

I have a friend from California who is an attorney that helps people of size gain access to bariatric surgery who has personally done very well with the “Band over Bypass” option and is very pleased with his results.

I believe “Band over Bypass” is the best option presently available for these patients and is not that difficult to perform. Hopefully this technique will help persons of size who continue to struggle despite a gastric bypass operation.

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Can numbness, tingling and weakness be symptoms of a nutritional deficiency?

Yes. Although there are other possible causes of these symptoms such as multiple sclerosis, strokes and other brain or spinal cord problems, vitamine and mineral deficiencies can cause these symptoms.

I saw a patient in my office this week who had not been back to see me for regular visits because she “felt fine” and did not feel she needed to follow up with me. This was despite me explaining to each patient that they need to continue to get regular evaluations to avoid nutritional deficiencies.

Unfortunately she was sent back to me by her neurologist because she had developed symptoms of numbness and tingling in her legs.

I ordered several lab tests including vitamin B1, B6, B12, copper and zinc levels as well as a CBC and a complete metabolic profile to find out what might be causing the problem. However, this gives me an opportunity to review some vitamin and mineral deficiencies that are known to cause neurologic problems if vitamin and mineral supplements are not taken to prevent these problems.

A gastric bypass operation also bypassed the first part of the small intestine called the duodenum which helps to absorb the B vitamins and minerals such as iron, calcium and copper.

If a gastric bypass patient does not take a daily multivitamin that contains vitamin B1, also called thiamine, a thiamine deficiency can occur resulting in confusion, unsteadiness and weakness numbness of the legs. This can occur after several weeks or a few months of not taking the vitamins. If this would happen urgent intervention is needed with replacement of this vitamin with an IV directly into the blood stream as well as with treatment by mouth. If this is treated promptly it is likely that these symptoms will improve rapidly.

After several years of not getting enough vitamin B12 after a gastric bypass can result in visual changes, numbness and painful tingling and weakness of the legs and can cause anemia. Many people including women that are menstruating need to take supplemental Vitamin B12 in addition to the multivitamin each day.

Also, we also need a small amount of the mineral copper each day to meet our body’s needs and to avoid symptoms that are similar to vitamin B12 deficiency. This only happens after several years of not getting enough copper. Usually we get enough of this mineral in our diet. However if someone is taking Zinc it make absorbing enough copper more difficult. Also denture paste contains Zinc and could get in the way of absorbing enough copper if a person has had a gastric bypass.

Having discussed these issues it is important to understand that these are very infrequent problems and can be avoided by having your vitamin levels checked at least once a year, taking a multivitamin and any other supplements as directed and keeping your follow up appointments.

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