DS Revision and Pancreatic Insufficiency

[pattercat]

I had a revision from RNY to BPD-DS June 2018. My highest weight (pre-RNY) was about 450 and at the time of my revision I hovered between 275 and 300. I just couldn't lose below 275 though and consulted a surgeon in Indiana. He was great, and even though I've had some issues, I would still do the revision again. Honestly, I wish I had fought for BPD-DS the first time around, I just was younger and didn't advocate for myself then as much as I do now. Today I'm hovering between 180-185.

I have normal malabsorption issues and really depend on my vitamin supplements. However, this past year I started having some major issues that I kept attributing to my BPD-DS and didn't discuss with my doctor when I should have. Long story short, after months of multiple yucky GI issues, feeling very weak and losing weight without trying, I saw my doctor. What really started to scare me was losing a lot of muscle mass. In the end, I've been diagnoses with EPI (Exocrine Pancreatic Insufficiency) and that causes even more malabsorption issues and I was super low on my ADEK vitamins.

I've started taking Creon with every meal and it has really helped, along with doubling my already high vitamin supplements, I'm slowly starting to feel better. What sucks is that the Creon looks like it will be a lifetime commitment since the pancreas does not heal. I can certainly tell when I don't take my Creon.

I'm really curious how many others who had a Duodenal Switch have ended up with pancreas issues. I did some research and while it is rare for a WLS patient to develop EPI, there is evidence that 5 years + post-op for DS that the risk level of having pancreas issues increases.

 

[southernlady]

Welcome, @pattercat
What would help is lab work to help you. We would also need to know what vitamins you already take now. I’ll take you in the vitamin section.

 

[JackieOnLine]

Hello, Pattercat!



I think age (and especially less than ideal healthcare, frankly) forces us to self-advocate.

 

[hilary1617]

@pattercat I unknowingly had (neuroendocrine) pancreatic cancer lurking at the time I underwent DS - It first was identified on scans about 30 days post surgery. I've since had a distal pancreatectomy. I went on Creon while recovering from the pancreatectomy.

This may be a bit impolite, but while, Creon does a great job at increasing absorption, it is definitely harsh on the tailfeathers. Welchol (colesevelam), a bile salt sequestrant, does a great job at countering the burning / acid stool experience that Creon can cause. Something to consider if that becomes an issue for you...

Also, for what it's worth, I no longer need Creon, and haven't had a bout of pancreatitis in a long while. So, there's hope!

 

[pattercat]

Welcome, @pattercat
What would help is lab work to help you. We would also need to know what vitamins you already take now. I’ll take you in the vitamin section.

Thank you southernlady.

I don't need assistance with the vitamins - I'm having regular labs done and my numbers are improving after starting on Creon. I was posting more about the onset of EPI after DS surgery.

Since the vitamins I was deficient in are fat soluble and my pancreas issues were not digesting fat, my vitamin levels were dropping. For the longest time I was taking Celebrate High ADEK for DS patients and was okay, but with the pancreas stuff setting in my E, K and D levels tanked pretty quickly.

I've actually switched now to a vitamin blend also high ADEK by AbbieVie (makers of Creon) but I'm taking a double dose and also supplementing with E, D and K additionally until my levels come up and stabilize.

 

[southernlady]

@pattercat, we do not recommend the ADEK at all. They are expensive, barely sufficient, and can not be adjusted. Multis are basically a filler for what we can’t get separately. We recommend a generic Centrum equivalent, most of us who have a Costco membership use the Kirkland Daily Multi Blue label but any generic Centrum equivalent that has no more than 2 mgs of B6 per dose is best.

 

[pattercat]

@pattercat, we do not recommend the ADEK at all. They are expensive, barely sufficient, and can not be adjusted. Multis are basically a filler for what we can’t get separately. We recommend a generic Centrum equivalent, most of us who have a Costco membership use the Kirkland Daily Multi Blue label but any generic Centrum equivalent that has no more than 2 mgs of B6 per dose is best.

Thanks for the advice. Fortunately, the makers of Creon have a program where they send me an ample supply of vitamins at no charge - but I'm still also taking supplements. Again, I'm doing this under doctor supervision until I am stabilized again with acceptable levels.