years after surgery to re-evaluate. Treatment for osteoporosis could include supplementation with Calcium 1200 mg/day and Vitamin D 800 IU/day. Standard supplementation for patients includes a multivitamin with minerals three times a day; calcium and a diet containing 1.0 to 1.5 grams of protein/kg per day. Any deficiencies reflected in lab work should be corrected immediately. Decreased iron absorption, as well as low levels of vitamin A, can result in iron deficiency anemia. This anemia results in low red blood cell counts and can lead to fatigue and weakness, as well as problems with the immune system. Iron deficiency can develop in SGB/RNY patients, particularly women who are still menstruating. Iron levels and any other related blood levels are checked each year after the SGB/RNY to ensure no deficiencies develop. Even following the guidelines for a healthy diet with supplements, a few SGB/RNY patients may experience excessive weight loss and get too thin. If appropriate supplementation cannot reverse the problem, the bypass portion of the SGB/RNY can be reversed or revised to allow improved absorption of calories. Excessive weight loss is rare, occurring in less than one percent of patients. A small number of patients experience insufficient weight loss and don’t reach goal weight. It is very important to discuss a goal weight with your surgeon. If patients do not reach goal weight within two years of the original SGB/RNY surgery, a “revision” surgery may be required. This surgery consists of moving the bypass “further downstream,” possibly from a six-ft bypass to a 12-ft bypass. All morbidly obese patients have some degree of fatty deposits or fatty liver disease within their livers. The amount of deposits can range from mild to bordering on severe or cirrhotic-type changes. The majority of these changes will improve or resolve as a result of weight loss. While these changes are taking effect, it is possible to have a worsening of one’s liver function. For this reason, the recommendation is to avoid items that can be damaging to the liver, such as alcohol and acetaminophen (Tylenol). When any new medication is prescribed, ensure the prescribing doctor checks the effect this medication could have on the liver and new, smaller stomach. Patients undergoing rapid weight changes are also at high risk for developing gallstones. A medication called Actigall is prescribed as a sort of bile “antifreeze” to keep patients from forming gallstones. The dose is 300mg twice daily and always should be taken with food. This routine begins two weeks after surgery and continues as long as weight loss is rapid (10 or more pounds per month). Even patients without a gallbladder may benefit from Actigall as it is possible to form stones within the bile ducts themselves. Some patients have significant abdominal pain when taking Actigall and may need to discontinue its use after discussion with the surgical team. Any abdominal operation can produce internal scar tissue, resulting in a bowel obstruction, both short term as well as long term. The SGB/RNY procedure has had a less than one percent incidence of bowel obstruction. Any procedure producing malabsorption can result in diarrhea. Most SGB/RNY patients can manage this issue with fiber supplements. The recommendation is to consume one teaspoon of Citrucel dissolved in three ounces of liquid twice daily beginning discharge day from the hospital and continuing for life. A hernia, or hole in the muscular layer of the abdomen, is very rare and seen in less than one percent of patients. Pregnancy after SGB/RNY is often successful, with those patients having healthy babies. However, it is strongly recommended that women abstain from becoming pregnant for at least the first year after the SGB/RNY as their bodies are undergoing a dramatic change and may not achieve adequate weight loss. In addition, hormone- based contraceptives will likely not effectively prevent pregnancy after the SGB/RNY. Due to changes in estrogen levels, fertility may be increased. Please coordinate increased contraceptive needs or pregnancy plans with obstetrics/gynecology.
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