Dear Friends,
IT FEELS SO GOOD TO BE BACK ONLINE! Actually I'm only on a borrowed computer
but it still feels good!
For those of you who missed WESDAY last Saturday......it was a rousing success.
It was just wonderful to be able to show Wes how much we appreciate him. For
those of you who missed it, we were able to give him a gift certificate for a
suit, shirt, tie, belt and socks. When he's finally ready to go out and make
the world a better place for people like us. I have no doubt that he'll CHANGE
THE WORLD!!!
HO HO HO - MERRY CHRISTMAS!!!!!
2002 F.A.C.E.S. of WLS Christmas Party
December 21st at 3:00
A fun time will be had by all. We're asking each family to bring a dish
(nothing HOT - as in needing to be plugged in to be kept warm - spicy is o.k.)
We just want finger foods and we'll enjoy nibbling. ONE OF OUR GUESTS IS
ALLERGIC TO ANY TYPE OF SEAFOOD INCLUDING TUNA, CRAB, ETC. PLEASE DO NOT BRING
DISHES INCLUDING THESE INGREDIENTS. We will also be playing Dirty Santa again
(only this year we'll be having a "3 Steal Limit" to prevent the flashlight
wars!) The gift limit for Dirty Santa is $15.00 so we know everyone will get a
nice gift. You must bring a gift to be able to play. Women bring women's gifts
and men bring men's gifts. Each gift must be wrapped and the tag should only
say MAN or WOMAN. Please keep gift prices as close to $15.00 as possible so
everyone will get comparable gifts. THIS IS GOING TO BE SO MUCH FUN!!!! This
party is not the best environment for small children therefore we would ask that
you find sitters for your little ones. They'll have more fun and you'll enjoy
having a day out!
Good info for gastric bypass patients from SPOTLIGHTHEALTH.com about B-12
Vitamin B12
October 1, 2002 - Sally Myers, RD, CPT
B12 or cobalamin is a water-soluble vitamin. It helps maintain healthy nerve
cells and red blood cells as well as assisting in making DNA. The Roux-en-Y
gastric bypass (RYGB) transects or partitions off the lower stomach. The first
one to four feet of intestine is also bypassed in a proximal/medial RYGB
depending on the surgeon. In a distal RYGB, typically the last four feet or less
of intestine (ileum) is left to absorb nutrients. The biliopancreatic
diversion/duodenal switch (BPD/DS) leaves more of the stomach and the pyloric
sphincter muscle in the stomach intact, but also only leaves four feet or less
of small intestine left to absorb nutrients. This is somewhat simplified as the
alimentary limb (where the food goes down) also absorbs some nutrients as well
as the common channel.
The process of B12 absorption is as follows. Hydrochloric acid and pepsin
released in the stomach are needed to separate B12 from protein. After the B12
is separated from protein, it attaches to R-binder proteins found in saliva and
gastric juice. Next, pancreatic enzymes in the upper small intestine release the
B12 from the R-binder proteins. The B12 then binds to intrinsic factor and is
carried away to the distal ileum where it is absorbed. When part of the stomach
is removed or partitioned off, cells are loss that secrete stomach acid and
intrinsic factor.
Bypassing the upper part of the intestine can also interfere with the mechanism
of B12 absorption as well as H2 blockers taken for treating stomal ulcers after
RYGB and rapid transit time of nutrients. Other issues that can decrease
absorption of B12 are inflammation of the stomach or intestine and excess
bacteria in the stomach and small intestine.
Lack of intrinsic factor can lead to pernicious anemia which can result in
permanent nerve damage if not treated. Pernicious anemia is a chronic condition
that must be treated for life, usually with an intramuscular injection that goes
directly into the bloodstream. B12 can also be absorbed via the mucous membranes
of the nose or under the tongue to the bloodstream so these are also other
viable ways of treating anemia in some individuals.
Clinical signs of B12 deficiency may include fatigue, weakness, nausea,
constipation, gas, loss of appetite, and weight loss. Other physical signs are
numbness and tingling of the hands and feet, difficulty in maintaining balance,
depression, confusion, poor memory, and soreness of the mouth or tongue. Some of
these symptoms can also result from a variety of other medical conditions so it
is important to see your surgeon and discuss these issues should they arise. The
Schilling test may be used to determine problems of intrinsic factor
availability. Most surgeons are monitoring B12. If yours is not, you may want to
urge him/her to do so.
The DRI for B12 is 2.4 mcg (micrograms) for men and women. In a study by Rhode,
Tamim, Gilfix et al., it was found that it took a minimum of 350 mcg of oral
crystalline B12 daily to sustain normal levels of B12 in 95% of RYGB patients.
B12 is an unusual vitamin in that you actually store a yearās supply or more.
Many patients donāt tolerate or eat foods high in B12 after bariatric surgery
so their stores slowly dwindle along with the lack of absorption caused by the
surgeries. It may not be possible to get enough B12 from food after surgery
again because of the interference in the absorption process and lack of gastric
juice and intrinsic factor. Deficiency may not show up for to two years or more
after surgery depending on the personās nutrition status before surgery.
Vitamin C in doses of 500 mg or more, taken with meals or up to one hour after a
meal, may diminish B12 availability from food or destroy the vitamin.
The normal range for serum B12 is 250 to 900 pg/ml, the range will vary
depending on which lab your blood work is sent to. Anything under 160 is
considered critical. B12 has no known toxicity level but there is no reason to
have levels way over 900 either. B12 levels should be checked pre and
post-operatively to make sure patients stay within their usual range if it was
acceptable pre-surgery.
Some food sources of B12 are as follows: 3 ounces of beef liver, 60 mcg, ¾ cup
of 100% fortified breakfast cereal, 6 mcg, 3 ounces of cooked rainbow trout, 5.3
mcg, 3 ounces of cooked beef, 2.1 mcg, 3 ounces of canned water packed tuna, .9
mcg, 1 cup of milk, .9 mcg, 3 ounces of cooked pork, .6 mcg, 1 egg, .5 mcg, 1
ounce of American cheese, .4 mcg, and 3 ounces of cooked chicken, .3 mcg.
In general, vitamin/mineral supplements should dissolve easily and be consumed
with food so absorption and toleration will be greater. Smaller doses taken more
often are more effective than one large dose as only 10 to 30% of any food or
supplement consumed is absorbed at one time.
Loose powder, liquid, soft-gel caps or quick dissolving tablets usually allow
for greatest absorption. Chelated minerals are best absorbed. When minerals are
chelated, they are bound to other substances to aid in absorption. The highest
absorption substances are malate, ethanolamine phosphate, ascorbate, citrate,
fumarate, peptonate, succinate, lysinate, glycerate, picolinate, and acetate.
Moderately high absorption substances are amino acid chelates, aspartate,
chloride, sulfate, gluconate, and phosphate. Lowest absorbing are carbonate and
oxide. Synthetic is fine as the cost of natural vitamins is usually too
expensive. One exception is Vitamin E. Use the d form, not the dl. Synthetic
fat-soluble vitamins are difficult for the liver to break down and utilize.
Supplements should be used under medical supervision. A typical schedule for
labs is every three months the first year, twice the second year, then on an
annual basis after the first two years post-operatively to monitor nutrition
status. It is important that patients take their supplements as directed and
follow-up with their surgical team to optimize their health and surgical
outcome.
What do you think of the recent lawsuit with McDonalds? Personally I think it's
a little ridiculous. How can parents sue McDonalds for their children being
obese after they ate McDonalds "every single day"? Sounds to me like these
folks need some assistance with their parenting skills! It makes for good
discussion though. Let me know what you think!
DON'T FORGET TO BRING YOUR GOODIE BAG SUPPLIES TO THE NEXT MEETINGS! THIS IS A
FUN PROGRAM AND FOLKS REALLY APPRECIATE THE STUFF! YOU CAN BRING
NON-PERISHABLE, GASTRIC BYPASS APPROPRIATE ITEMS TO THE SUPPORT GROUP MEETINGS
AND WE'LL MAKE GOODIE BAGS TO GIVE TO FOLKS AT THE MEETING BEFORE THEY HAVE
THEIR SURGERY!
ARE YOU SIGNED UP TO BE AN ANGEL? DO YOU NEED AN ANGEL? AN ANGEL IS A SURGERY
"BUDDY". A PERSON WHO CAN TALK TO YOU WHEN YOU'RE NERVOUS, HELP YOU FIGURE
THINGS OUT, GIVE YOU A HUG WHEN YOU NEED IT AND BASICALLY JUST LOOK OUT FOR YOU
DURING YOUR JOURNEY! IF YOU'RE NOT PARTICIPATING IN THE ANGEL PROGRAM YOU'RE
REALLY MISSING OUT! CONTACT THE ANGEL COORDINATOR, Lisa Robbins, AT:
FOWLSANGEL@...
TO SIGN UP FOR THE PROGRAM. YOU'LL BE GLAD YOU DID!
According to USA Today...........
Bariatric surgery emerges as drastic remedy for obese kidsCHICAGO (AP) ā
Drastic surgery for obesity, once viewed as suitable only for adults, is
emerging as an option for children, a new pediatrics report says. Courtney
Dunham, a high school senior, listens to instructions during band practice.
After numerous attempts at dieting Dunham chose gastric bypass surgery to lose
weight.
Al Behrman, AP
Whether gastric bypass surgery, which shrinks the stomach from the size of a
football to the size of an egg, might have long-term side effects for youngsters
is unknown. But with childhood obesity reaching pandemic proportions, some
families and their doctors see it as the only effective solution. Researchers
also haven't determined what age and weight a youngster should be before
surgery, or whether the surgery, which can result in nutritional deficiencies in
adults, could interfere with a child's use of bone-building calcium, said
authors of a report in November's issue of Pediatrics. Youngsters in one recent
study who underwent gastric bypass were 15 to 17 years old, a time when peak
bone mass is occurring, said the authors, Dr. Sue Y.S. Kimm of the University of
Pittsburgh and researcher Eva Obarzanek of the National Heart, Lung and Blood
Institute. Because childhood obesity is so pervasive ā about 15% of youngsters
are severely overweight or obese ā more research "is urgently needed," they
said. Doctors say demand is strong, bolstered in part by famous patients like
pop singer Carnie Wilson, who dropped from about 300 pounds to 148 after an
Internet-broadcast surgery in 1999, at age 31. Most of the more than 100,000
people who are likely to have the surgery this year are adults, said Dr. Walter
Pories, president of the American Society for Bariatric Surgery. He has no exact
figures on how many children have undergone obesity surgery, but in an informal
survey of 600 group members earlier this year, about 10 said they had done
surgeries on children, all with positive results. Some doctors cringe at the
thought of subjecting youngsters to elective surgery that's so extreme. "People
change their habits. Doing something in the first 20 years that can affect you
for the next 50 years ... ethically it's very hard to justify that," said Dr.
Timothy Sentongo, a gastrointestinal specialist at Chicago's Children's Memorial
Hospital. For some children who have exercised and dieted to no avail, surgery
is the only alternative, said Dr. Henry Buchwald, a University of Minnesota
surgeon who has done obesity operations on 18 youngsters under age 18. "Their
life is turned around from being ridiculed at school to living a normal child's
life," he said. Ideally, patients should have achieved their maximum growth,
said Buchwald, though his youngest was a 13-year-old who was about 150 pounds
overweight. Families should be told about surgery consequences, which may
include malnutrition and gallstones. "They're going to have to restrict their
eating behavior or they'll just vomit and be uncomfortable," he said. Ohio
teenager Courtney Dunham says the risks were worth it. The high school senior
says she has been teased since kindergarten, when a classmate said she triggered
earthquakes when she walked. Before her Aug. 2 surgery, she weighed 329 pounds
ā at 5-feet-3-inches, nearly 200 pounds overweight. So far she's shed 40
pounds, with no side effects. Her goal is to fit into size 16 jeans. "It was a
pretty big step, but ... it was the right thing to do," she said. Her family is
prone to obesity and associated ailments like diabetes and heart disease, and
Courtney knew she was pushing her luck. The doctors assured her that her biggest
concern ā that surgery might rule out eventual motherhood ā was unfounded.
So shortly after her 18th birthday, she underwent a two-hour gastric bypass, the
most common type of bariatric surgery, in which a small stomach pouch is created
by stitching the stomach's upper portion closed. The intestine is redirected to
attach to the pouch and to bypass a portion of the small intestine that normally
absorbs nutrients. The operation results in weight loss by reducing food intake
and nutrient absorption. Courtney is now required to eat no more than a cup of
food a few times daily, but must avoid sugar, which can cause symptoms including
nausea, rapid heartbeat and stomach bleeding after the surgery. Dr. Victor
Garcia, who runs the program with Dr. Thomas Inge, has done similar operations
on about six youngsters; four more are scheduled for surgery this month. Not
every obese youngster is a candidate, Garcia said. "We have refused a number of
patients for whom we felt the family would not be supportive," he said. "It's
challenging because most parents are overweight along with the child."
Well folks, that's it for today. Remember to tell Wes and Lisa THANKS for
letting me use thier computer so I could send you this email so you'd know to
come to the Christmas party.
OH AND DON'T FORGET THAT WE HAVE A MEETING ON MONDAY (DAY AFTER TOMORROW) AT
6:00. WE'LL HAVE PROTEIN SUPPLEMENTS AVAILABLE TOO!!
I appreciate you all and hope you have a wonderful Thanksgiving! I am so
thankful for friends like you!
Love and Hugs,
Rona
Your Bari-Godmother