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chapped lips, fissures -low vitamin level

margaretgiberson
on 3/29/10 10:22 am - North Augusta, SC
Anyone have extremely dry, chapped lips, extra saliva and mouth fissures since surgery.  This started with me about nine months ago.  I am 1 1/2 years out from RNY and am having a tough time with this.  My labs have been perfect.  Any suggestions?  My dentist prescribed a medication but I want to prevent it.  She said my B, iron and zinc levels have to be low??  Help anyone?
Andrea U.
on 3/29/10 10:38 am - Wilson, NC
Well, zinc helps with protein synthesis.  Most docs don't check for zinc unless we ask for it.  Has yours?

And when you say your levels are pefect -- are you looking at your own labs or are you trusting a doc?  I ask because many docs don't go by optimal levels -- only what the lab considers "in range" -- and many times that is much lower than what we need.  Do you have your lab sheets?

These conditions tend to happen with low vitamin levels.  I agree with your dentist on this case -- when was your last FULL vitamin draw -- and I mean something like a 15-18 vial draw?

And what vitamins do you take daily?


margaretgiberson
on 3/29/10 10:47 am - North Augusta, SC
I had surgery at a Center for Excellence and Dr. Blaney is very up on the RNY so I, of course, assumed he is telling me his opinion since he is the doctor and, yes, I do trust his opinion.  I just had a full vitamin draw about two weeks ago and was told it was right where it should be by his office.  I see him in two weeks and will address my concerns.  I take Bariatric Advantage vitamins- Iron, Probiotics, multivitamins, Calcium citrate, zinc, the orange omega fish oil- hey, I will add more- give me your opinion what do I need??
poet_kelly
on 3/29/10 11:20 am - OH
I didn't see B12 in there, and you need that.  But other than that, I don't think anyone here can suggest what else you might need unless you can tell us what your labs were.  Did you get a copy of your lab report?  If not, it's a good idea to ask for you.  You could post the results here and people could make suggestions.

I'm not suggesting your doc isn't a good doc.  But Centers of Excellence don't always give good vitamin advice.  They aren't required to by the ASMBS, which is the organization that names places Centers of Excellences.  They can tell people to take Flintstones and Tums and still be a Center of Excellence.  And many surgeons are really good at cutting but don't know much about nutrition.  They just don't learn much about it in medical school.

Kelly
Andrea U.
on 3/29/10 11:21 am - Wilson, NC
I went to a COE and was told Tums and Flintstones.  There are COEs telling Tums and Flintstones.  There are COEs that don't advocate iron, b12, or citrate.

My point is this -- get your own labs, put your own eye balls on it, and look see yourself.  Cause you can't trust ANYONE but yourself.  I can attest to that as I got a ferritin of 7 (that's REALLY bad) and RICKETS out of the deal by trusting my doc.  And I love the man.  I'd let him cut me up again in a heartbeat -- just not tell me what kind of vitamins to take.


I can't tell you what to take without knowing your numbers.  Get me your lab sheets and we can talk.  Until I know what your levels are -- and given you have some issues?  There has to be something wrong somewhere -- your dentist is right there.  But get levels and we can talk.

Call and have them send you the lab sheets in the mail.

But answer this -- how many vials of blood did they take?  My last draw was 15 and they still missed some key things.


poet_kelly
on 3/29/10 11:37 am - OH
Andrea, can ask what labs you get done?  Or is it on your blog somewhere?

Last time I had labs done I think they drew ten vials.  Somehow they forgot the B1 even though I specifically asked for it and I know the doctor ordered it.  I got the lab report and it just wasn't on there.  There are a couple other things I know they didn't do that I think I may ask for next time but sometimes it hard to figure out what you need.  It seems like every time I see someone post a list of what they get done, everyone does something slightly different.  And I know my surgeon doesn't really think I need everything I think I need, but my PCP will order whatever I ask for.

Kelly
Andrea U.
on 3/29/10 11:58 am - Wilson, NC
I was having numbing in my hands and I very specifically needed copper pulled (in addition to all the B's) as it has a neuro component.  I also needed Vite A pulled since I take the Dope.  Both were neglected.  You'd think that they would have been grabbed.. but no.

(And the neuro things the numbing is a rhumatology problem.  Which means I lose my triptans.  I'm thrilled.  Can't you tell?)


*80053          Comprehensive Metabolic profile: (sodium, potassium, chloride, glucose,BUN, creatinine, calcium, total protein, albumin, total bilirubin, alkaline phosphatase, aspartate aminotransferase)  (10231)

* 84134          Pre-albumin:

* 7600            Lipid profile: (cholesterol, HDL, LDL, triglycerides, chol/HDL ratio)

* 10256          Hep panel: includes ALT (SPGT) & GGT)

* 84100          Phosphorous – Inorganic:  (718)

* 83735          Magnesium:

* 84550          Uric Acid:  (905)

* 7444            Thyroid panel: (T3U, T4, FTI, TSH)  (84437; 84443; 84479; 84480)

* 85025          Hemogram with platelets:  (1759)

* 7573            Iron: TIBC, % sat

* 83550          Ferritin:  (457)

* 84630          Zinc:  (945)

* 84446          Vitamin A:  (921)

* 82306          Vitamin D: (25-hydroxy)   (680)

* 84052          Vitamin B-1: (Thiamin)  (4052)

* 84207          Vitamin B-6: (Pyridoxine)

* 7065            Vitamin B-12 & Folate:  (82607; 82746)

* 83970          Serum intact: PTH

* 83937          Osteocalcin:

* 84597          Vitamin K:

* 85610          PT:

* 85730          PTT:

 

2ND GROUP

 

* 593              LDH:

* 31789          Homocysteine, Cardio:

* 83921          MMA:

* 367              Cortisol:

* 84255          Selenium:

* 84590          Vitamin E:

* 82525          Copper:

*496 - HEMOGLOBIN A1C

 


poet_kelly
on 3/29/10 12:06 pm - OH
OK.  I get most of those things.  I don't normally get a thyroid panel because I've never had a thyroid problem.  But I did have one done a couple months ago on the advice of my PCP.  But all was normal.

I have not had E or K or B6 or selenium done but was thinking of asking for them next time.  Are those common deficiencies are RNY, do you know?

And I don't even know what osteocalcin is.  Can you explain it to me?

Thanks so much for your help.

Kelly
Andrea U.
on 3/29/10 12:15 pm - Wilson, NC
My K just dropped.  My PT and PTT are low.  I'm now supplementing in K.  Keep in mind that A, D, E and K are all fat soluble so we are just at risk.  So yes, you should get them pulled.

B6 is a toxic level vite.  WE CAN GET TOXIC ON IT.  It's not a level of B12 of "there are sporadic cases" -- this is a "people DO get sick" off it.  Selenium is emerging more and more with hearth health. 

Osteocalcin is a newer test for bone health:

Osteocalcin is a noncollagenous protein found in bone and dentin. It is secreted by osteoblasts and thought to play a role in mineralization and calcium ion homeostasis. It has been stipulated that osteocalcin may also function as a negative regulator of bone formation, although its exact role is unknown.

In August 2007, it was reported[1] that osteocalcin acts as a hormone in the body, causing beta cells in the pancreas to release more insulin, and at the same time directing fat cells to release the hormone adiponectin, whi*****reases sensitivity to insulin.

Use as a biochemical marker for bone formation

As osteocalcin is manufactured by osteoblasts, it is often used as a biochemical marker, or biomarker, for the bone formation process. It has been routinely observed that higher serum-osteocalcin levels are relatively well correlated with increases in bone mineral density (BMD) during treatment with anabolic bone formation drugs for osteoporosis, such as Forteo. In many studies, osteocalcin is used as a preliminary biomarker on the effectiveness of a given drug on bone formation.





rbb825
on 3/29/10 9:04 pm - Suffern, NY
selenium is very important to get checked.  I have been deficient since my 9 month labs and have been taking 200mcg daily plus the 55 mcg in my multi twice daily, so I am getting 310mcg daily and I am still at the low end of normal.  I am suprised you dont' get tested for this since you always tell people to take multis with it. 

I got tested for E and K once just to make sure I was okay.  My NUT said she will do them periodically to make sure.  I don't know what osteocalcin is either.

You are lucky to not have a thyroid problem.  I take 2 pills a day and have 4 cysts in my thyroid.

 

poet_kelly
on 3/29/10 9:08 pm - OH
My doc doesn't recommend testing for selenium.  It seems most docs don't.  And I take a multi that gives me 100% of the RDA for selenium twice a day, so I think my doc probably just assumes I'm getting enough.  But I think I am going to ask for it next time I get labs done.

Kelly
rbb825
on 3/29/10 10:17 pm, edited 3/29/10 10:17 pm - Suffern, NY
I would be curious to see how they come out.  My multi gives me 160% of RDA plus the extra 200mcg give me another 300% and I am just over the bottom of the level.  So, I get a total of 360%.

 

kmom1420
on 4/27/10 7:41 pm
K is usually standard on a metaboic profile (potassium).  Just FYI 
Beginning wt 286/ CW 279/GW135    
margaretgiberson
on 3/30/10 5:52 am - North Augusta, SC
thanks so much for all of the info- I got the medication that the dentist prescribed- did the swish and swallow and put the other prescribed med on my lips and when I awoke this morning -I was almost back to normal- Thank God- it was a shame that I have suffered through this for nine months or more- will take this list of labs when I see him- he has done most all of this except for some of the vitamins- my cholesterol and aic is great!!
Whirlwind
on 3/29/10 3:54 pm
RNY on 10/28/08 with
Low Zinc will cause fissuring at the sides of your lips.  Be sure you have had one done recently.  Don't just take your doctor's word for it.  Look and see for yourself.  Many docs do not measure zinc.
vitalady
on 3/29/10 8:41 pm - Puyallup, WA
RNY on 10/05/94
I understand. My surgeon is also my deity, to a degree.

But when I added some of the tests below, he said, "We don't have problems with ________." and I said, "That's because we've never tested them. But NATIONALLY, we do." so he agreed to baselines, which of course, were not good.

as I learn more, I add more. When I explained to him why we want MMA and homocysteine, he said, "Well, then, run CRP, too"

he respects me or I don't think I woulda gotten his autograph, for sure. LOL

My first draw was 17 vials. The next was 14, so I think they figured how to use some of the vials for more than one test.

But if you only had 8 vials, they're not testing for everything.

My labs are as close to perfect as I've seen and NOBODY has perfect labs. If they do, everything is not being run. Simple.

The thought being, as my own doc said, "We don't have problems with ________" OF COURSE they don't if they never test it!

It's critical to get all your labs since pre-op and track them, Excel or even by hand. Then LOOK AT THEM with your own eyes because nobody cares as much about you as you do.

Michelle
RNY, distal, 10/5/94 

P.S.  My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.