My Dad's Story - Why Proper Supplementation is Essential

nlamb80

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Portland, OR
Hi all!

I was personally asked by one of the lovely admins over at the Duodenal Switch Patients FB group to post this story about my Dad and his DS, so here we go!

Inadequate supplementation, as we all know, is the bane of most WLS communities. Trying to convince newbies that not only are their surgeons/NUTs wrong, but actually giving them dangerous advice is really hard. That's why I think my father's story is so important, and really illustrative of what can happen if you follow an inadequate or nonexistent regimen.

In 1995, my father had DS surgery with Robert Rabkin, John Rabkin's brother, in Ventura CA, before he moved his practice to San Francisco. The "chewable vitamin" advice is something they used to give out 20 years ago, because the Hess Method surgery was still pretty new in the US at that point, and they didn't have a ton of data on the supplementation requirements.

While the surgery itself was great and never gave him any complications solely on its own, he's neglected his supplementation.

What's the result of this? His body eventually went highly deficient. His blood albumin levels were low because of low protein, and he had weeping sores on his legs. He's had problems maintaining his blood salt levels. He's been anemic. He's been deficient in just about everything you can be deficient in, and it affected his cognition so severely it exacerbated his mental health issues and he passively and actively has attempted suicide. Yes, this can happen, low levels of B vitamins have been known to affect mental health pretty severely. That last part is a pet theory of mine, but one I feel has merit given how absolutely poor his health has been. Literally decrepit, I don't even remember all of the things he's had go wrong with him over the years.

This in and of itself is striking, but the most striking thing is his raging osteoporosis. How bad is it? His body is bent at almost a 90 degree angle, and he can no longer get around without a walker or motor scooter.

He has broken his back--BROKEN IT--at least half a dozen times now, and has had half a dozen back surgeries including bone fusion surgeries in order to repair the damage. His spine is so osteporotic, this most recent time when he broke a vertabra, they don't even know how it happened. He can literally sit down too agressively at this point and break his spine.

I am not exaggerating or kidding. I cannot stress this enough. I AM NOT EXAGGERATING. If it wasn't a violation of his privacy, I'd post a picture of him bent over like an 80-year old so you could see it.

How old his he? 63. And he looks EIGHTY years old. His body literally sucked all the nutrients out of itself in order to keep itself alive. When my 58-year-old mother goes out with him, he's been mistaken for her father more than once.

After I got my surgery, I absolutely nagged him to start supplementing properly and to go see a legit endocrinologist. He did finally, and his endocrinoloist said, in addition to his other deficiencies, he had the lowest levels of D he'd ever seen ... they just DIDN'T EXIST.

I'm two years out from surgery with John Rabkin and doing really well, and I give a lot of that credit to the community, and to Rabkin's team for pushing reasonable nutritionial and supplement standards towards their patients. My father is alive right now because I went up his butt and around the corner to start taking care of himself. Now my dad is supplementing properly and is feeling better than he ever has, but the damage is done, and is irreparable at this point. His spine issues will likely kill him.

It makes me very sad not only because he's my father and I love him, but also because at 20 years out, he'd be one of the oldest vets around these parts, and could have been a source of very valuable advice, if only he'd kept up on things and not been such a stubborn old curmudgeon about it (yes, I tell him this, LOL). He actually WAS involved heavily in the support community for the first five years after his surgery, but then he had a seizure and broke his back, and it was all downhill from there. He basically gave up, because he was depressed as a result of going from riding bike marathons to being incapacitated.

He's now a cautionary tale and a powerful anecdote.

I'm not posting this to scare newbies away from the surgery, quite the contrary. I'd like to emphasize that with proper diet, hydration, supplementation, and bloodwork, this surgery is a wonderful asset to you which will change your life. You'll be fine if you follow the tried-and-true advice of the vets around here! But please, please do not neglect yourself and end up like this.
 
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Thank you SO much - it is even more of a testiment to the DS, I believe, that despite seeing what happened to your father, you took the leap to have the same surgery, but with the commitment to TAKE BETTER CARE of yourself. I am going to be 12 years out in 2.5 weeks, and I've been very diligent (without going overboard, I think) about supplementation. I will be 62 12 days after my 12th surgiversary, and just got my labs back and reported them (http://bariatricfacts.org/threads/this-years-annual-labs.3145/) - this year, I am adding copper (low for the first time) and Vitamin A (yes, I never needed it on the past and I'm not below range, but the trend is pretty obvious so I'm going to add it in), plus taking some niacin because the levels are weirdly low (thought the report doesn't clearly say so), and try to up my protein a little with supplements, even though I don't like them, because I haven't been as hungry for protein lately as I have been in the past (my desire for protein has always matched my needs in the past - but I can't let my lack of interest rule what I know I need to do!).

Welcome, and I hope you'll stick around! Maybe you can get your father to read here too?
 
You're very welcome, and I'm glad his story can be of some help! I hope it doesn't sound like I'm trashing him, as that's not my intention at all, I realize it could come off that way. I love him very much, and he knows he's been a goober about all of this.

Honestly, if he'd had a ton of complications from the surgery itself, it may have scared me away. But I saw that the surgery itself was sound, and really, I didn't think a lot of his health issues being related to his DS until I started researching on my own, some even as a newbie post-surgery. But thanks to these communitites and to Rabkin's team, like I stated, I know it's possible to live a healthy life if you accept and embrace the lifestyle change that comes along with the DS.

I posted this thought in the FB group too, but it bugs me that in 20 years, not one doctor or surgeon put two and two together with all of his massive health complications and the DS. Sort of frustrating. I mean I didn't put them together, but I'm also not an MD.

Funny aside: the surgery was so new when he had it, that he had to wear a piece of microfilm around his neck on a chain in case he got in an accident or something.

Anyway, the real irony is though that if he'd supplemented, his DS would never have given him any problems, because he's never had a hernia, a blockage, not so much as a stricture related to the DS itself!

You're always one of the vets that I think of, Diana, when I think of Rabkin patients. I'm sorry to hear you're trending down in your A, because I know you've always been happy you've never had to add it in. Ah well, gotta do what you gotta do, right? :D
 
What an amazing post and cautionary tale of the need for true diligence in maintaining our nutritional status post op. I also wonder about things like his CC length and whether or not it was too short for his needs. The more I look into nutritional problems for DS Pt.'s post op 1,2, 5 yrs it seems that those losing too much weight and battling nutritional deficits are often men. Not exclusively for sure, but disproportionally men, especially when it comes to excessive weight loss. I'm happy that he has now, no doubt with your guidance and support, gotten back on track, though it's sad to think of the damage already done to his body. He was a pioneer....a trail blazer for the rest of us. I do hope he's willing to share his story with the medical community...and maybe even allow himself to be studied for posterities sake. Thanks for sharing this!!
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He has a short CC, 50cm. He was one of the last to have that length with the Rabkins' team, I believe, as it was proving too short for a lot of people. Even more of a reason for him to supplement!
 
I'm not heartbroken or even unhappy about needing to supplement with vitamin A now - but I do want to emphasize that (1) I didn't take it before, because I didn't need it, and I used that as an example of why people need to do their labs, and that there's no need to hyper-supplement without a basis for doing so (e.g., by taking ADEKs when all I need is D and K, and even those I didn't need for the first 5 years); and (2) that I am adding it now BEFORE it goes too low, because I'm TRENDING towards low - which I could identify early because I track trends, not just raw numbers. Same with copper - I didn't need it before, and now I do - I'm content to take it now that I do.
 
Yeah I totally understand that mindset. I'm similar. I don't have a ton of lab data on myself yet, but I always compare the labs that I have to try and spot anything beforehand. You have to do what you have to do, if your labs trend a particular way and you have to sling back Yet Another Pill every day, it's no big thing. Just part of the deal!
 
Exactly what @Will2014 said, an AMAZING post. Thank you for taking the time to share your story. I did a “Cut and Paste” (hope you don’t mind) of your post and emailed it to my Wife.

In addition to serving as a reminder/warning to us DS’rs, I think our closest Family members of DS patients should see info like this also so that it helps them better to understand just how severe this can get if we don’t get the proper nutrition and supplementation.

Unfortunately, your Dad is not the only example, I’ve seen several just within my short time on this journey.

Your Dad is very lucky to have you helping him and I give you both my best wishes for continued success and good health. And, welcome to the site! Rob
 
Actually @DianaCox he shared his op note with me awhile back and it was a real DS, much to my surprise. But he never got good nutritional advice and also didn't have good medical care in general for quite awhile after that, and I believe that's what led to the amputations. With appropriate education and compliance I very much doubt that this would have been necessary, but credit does go to the doctor who did the amputations that saved his life.
 
@DianaCox I believe it. I'm pretty surprised my dad has survived, TBH. He's had a couple of close calls, but he's a pretty tough guy. I think if it had been me I'd have died long before two decades.
 
First of all, I want to thank you for using paragraphs. I get so lost when someone doesn't and I have a hard time comprehending the message.

I worked in medical records and saw several cases of train wrecks. No one ever recovered, yet might have slowed the progress of their deterioration. As one might suspect, they were all bypasses. So not only did they suffer from inadequate supplementation, they almost always regained their weight. I put off my surgery for years, then the ever increasing health problems forced me to reconsider surgery.

I now consider my supplements to be *prescriptions*. I don't mess around with my thyroid meds; regular testing and adjustment as necessary. I find that taking that approach makes it easier to stay vigilant because, as you know all too well, it can have devastating results.

I also find it vital to stay connected. There is no face-to-face support group in my area that is worth my time. I treat this place as a requirement for my health. Rx: Read daily at least once, more if desired.

Your father's story is a good dose of reality. You're not trashing, you're testifying. THANK YOU!
 

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