Confused by my yearly appt. at Dr. Inman

[seeker1]

Need your help, as I am still in shock. A little history so you can have something to go by. I am 28yrs old. Lightweight going into DS. I am 5'5. A year out this May. I currently weigh 151. I saw my NP today and she was concerned about my Liver Enzymes being to high. She said it was not from fatty tissue or high cholesterol because my labs were all good. She wants to change medication, my PPI. She thinks it might have to do with that. However she wants me to check my ALT and AST in 6 weeks and if they still have gone up she wants to do a total revision of the DS leaving me only with a sleeve. I told her I did not want that! Has any of the vets encountered this before? Is their something else I can do, I can't believe that they would jump to a revision this early. I have had no serve complications from this and they have told me my labs are all good. Also the Dietician told me my Vit D levels were too high- 103.7 ( standard range is 20-50) when i asked what is the prolonged affects of high Vit D she said it will make your bones turn soft and brittle, any one heard that before? Any insights on why Dr. Inman would want to do a total revision at a year out without major complication other than elevated liver enzymes. Is there something that I am missing in all this, that you vets can shine some light on.

At 6 months ALT- 19 one year- 63
at 6 months ASt- 18 one year- 45

year lab= Calcium total - 9.6 (standard range- 8.5-10.5)
Protien total- 7.6 (standard range- 6.4-8)
Albumim -4.6 (standard range- 3.5-5)

 

[SHales]

Your liver labs will be high for the first year or a little longer due to the fast weight loss, they should level out after that. I also think she is going by old D levels. The Vitamin D Council says that you don't get the benefits of D unless you are over 80. I don't know much about Dr. Inman but there is no way I would let anyone do a revision without a 2nd, 3rd and 4th opinion!!! Did Dr. I say this or the dietician or NP?

 

[seeker1]

The Dietician told me about the Vit D levels. I met with the NP who told me she was speaking on behalf of Dr. Inman that they had discussed the issue.

 

[Terri]

What was your surgery weight? Doesn't rapid weight loss cause elevated liver enzymes? I am pre-op with Dr. Inman so I am very interested in this.

 

[seeker1]

My starting weight was 235.

 

[KathyF]

Did they explain why they thought a revision would fix your liver enzyme levels?

 

[seeker1]

No all the NP said was that my high levels were not caused by my eating habits, so she wants to know if medication is causing it and if not then she said it must mean your body doesn't handle the DS

 

[chevtow]

Wow. I've read nothing but good things about Dr. Inman, I'd make an appointment with her to verify that the NP isn't "jumping the gun". What is the long term consequence of elevated liver enzymes? Liver failure? I guess if it's a choice between the two I could see it, but not until numerous of the best DS surgeons told me so. Good luck and keep us informed.

 

[Terri]

The Dietician told me about the Vit D levels. I met with the NP who told me she was speaking on behalf of Dr. Inman that they had discussed the issue.

Previously I had met Dr. Inman's PA Jen and liked her. But this last time I met with her NP, Loanne (pronounced Lon). I didn't care for her as much. She had me follow up with a cardiologist for surgery clearance because she didn't like my EKG reading, said I may have had a heart attack at some point. Both my PCP and the cardiologist read the same EKG and said they didn't see anything that was wrong and nothing that indicated a heart attack.

You mentioned she wants to change your PPI. Did she say why? Have you had GERD? Nausea/vomiting? What about gallbladder? Do you still have it? It seems that these would maybe raise liver enzymes, since the liver produces bile. Also I thought I had seen where 0-45 was normal range on AST and ALT. I would definitely have an actual visit with Dr Inman and have her explain why. I would also consult and hepatologist.

 

[Happy DSr]

as SHales said, liver enzymes will often be high during rapid weight loss. The liver works hard to clear the excesses from our systems. That is also why drinking alcohol is a no-no during rapid weight loss as it puts too much strain on the liver. Now of course, you are at goal and are no longer in the rapid weight loss phase, but there may still some residual effect. You may want to review what your results were like during the past year

elevated results in the liver enzymes panel really just tell us that your liver has some inflammation. This says nothing about the cause. Usually doctors are concerned if the levels are extremely high (as in spiking to 200, for example) or when the results are consistently high for a longer period or if there is something in your medical history that causes concern (such as taking certain medications). In any case they would normally do a battery of additional blood work and urine work to narrow down the reason why the liver is inflamed. And a referral to a Hepatologist would be in order. They may want to do a liver biopsy (simple needle procedure) to get a sample of the liver to determine the problem, if not otherwise apparent.

It may be that your current PPI medication is contributing to the higher levels, so switching out the medication to an alternate may be a good thing. Sometimes a simple medication change fixes this right up. Retesting in a few weeks to see if that has helped is also a good thing.

If the results remain high in six weeks, it would mean your PPI was not the cause. You should discuss what kind of additional testing would be appropriate to determine the cause of the inflammation, including a possible referral, eventually. The mildly elevated levels certainly don't indicate any need for urgent action.

It sounds terribly premature for a discussion of a surgical intervention.

 

[Elizabeth N.]

Oh fer fucksakes. That's just SILLY. I hate it when docs do that kind of fearmongering shit.

 

[KathyF]

I agree with Happy DSr that further investigation is warranted, preferably by a Hepatologist, to narrow down what is causing the elevated numbers before rushing into major surgery again.

There was someone, unfortunately I don't remember his name, who was having problems with extremely high liver numbers and, if I remember correctly, it ended up being a reaction to a supplement.

 

[kirstabelle]

From what I have seen over the years - raised liver enzymes post WLS, during the weight loss period is the norm. What is being said about Vit D is bullshit.

 

[Sheanie]

Okay, (deep breath). Let me see if I get this now. The NURSE PRACTITIONER told you that you needed a complete take down of your DS because your liver enzymes are elevated? Not Dr. Inman, but her Nurse Practitioner. That's sketchy. A NP does not have the authority to order a surgical solution to anything. You are only a year out. Your labs will be adjusting all over the place, especially your liver enzymes. Go see a SPECIALIST about this. A NP doesn't even have enough education to talk about liver enzymes, let alone give surgical solutions to a bariatric patient. For crying out loud, you are only a YEAR OUT.

Your vitamin D is NOT high. It does NOT cause bones to go soft. That is complete nonsense.

I've been hearing some worrisome stuff coming from Dr. Inman patients lately. I would not follow with her very long after surgery. Her vitamin advice is SNG (shit no good) and will get you in trouble.

Google liver function during weight loss and read up on that. Study up on liver enzymes and educate yourself. Do NOT go under the knife for a revision. That advice is complete and utter bullshit.

 

[Larra]

First, remember that no one can force you to have surgery, and if it turns out that you really do need surgery (I have strong doubts at this point) you could discuss, by whih I mean insist upon, a revision of the lengths of the different segments of small intestine rather than a full reversal. So no need to panic.
Next, and perhaps of more importance, these elevations are so very mild that I don't see how they could be alarming. Now, if this is part of a disturbing trend that might be different, but this is just one point in time, and just after a year of rapid weight loss at that. I would hope a plan has been made to re-check your LFTs in a reasonable time frame and go from there.
And as someone else already pointed out very elequently, there are many, many possible causes of elevated LFTs and rather than jump into major surgery wth a reversal of a highly successful bariatric operation, it would only make sense to do a work-up to determine the cause of the elevated LFTs and deal with the cause rather than assume that it's from your DS.
And last, even though the NP discussed this with Dr. Inman before discussing it with you, I personally feel that such a drastic possible step should have been discussed with you by the doctor herself, not one of her surrrogates. I mean no disrespect to NPs, most of them are awesome, but this is far beyond their pervue. No one should have alarmed you over what might turn out to be temporary and insignificant.