Steroids, orally or by injection.

I use an herb called turmeric for chronic inflammation in my back.  It doesn't work quickly, like NSAIDS do - it can take a few weeks of daily use to notice a difference.  And it's not considered safe for everyone - people that take blood thinners shouldn't take it and diabetics should use it with caution, for example.  But it makes a big difference for me.

I don't know why she would think it was different than other NSAIDS.  Why not ask her?  She is really the only one that knows what she is thinking.

Personally, I would not be comfortable taking it.  What are you planning to do?

What does she think is "borderline" about them?  Three servings, which is what the label recommends, gives you 200% of most things, which is what the ASMBS recommends.  Yeah, you'd need to take iron separately since they have 500 mg calcium citrate per serving - that would block the absorption of any iron you took with them.  But that's the case with any calcium citrate supplement you take.

You'd need to take B12, too, in a sublingual, nasal spray, or shot.

You need 200 mg C for every 30 mg elemental iron, so you would need about 400 mg C with 65 mg carbonyl.

It means a 2500 mg serving of calcium citrate is about 20% elemental calcium.  We need 1500 to 2000 mg elemental calcium (from citrate) a day, so you need three or four doses of the Upcal D a day.

Protein bars, protein shakes, cottage cheese, sliced cheese and fruit, apple slices with peanut butter or almond butter, turkey bacon, veggie sausage, Egg beaters if your pouch likes those better than eggs, or a tofu scramble.  Or non-breakfast type food.  I sometimes have leftovers from dinner the night before for breakfast.

We malabsorb micronutients forever and yes, Medicare should cover them.  They have covered all my labs, every six months, since my surgery.  Actually, it was every three months the first year, but every six months since then. 

If you really like your surgeon, I would suggest speaking with him personally before looking for a new surgeon.  Tell him you really like him and feel he's provided good care but that you are fed up with his staff and their inability/refusal to code things correctly. Ask him if he can take care of that for you.  If he can't, then I'd start asking your PCP to order your labs.  Just take the PCP a list of what you need ordered.

I like the fact that he brought up the  moral/ethical issues related to diet, too.  I wasn't aware that he advocated a more humane diet.

I have to say that really, I don't think eating animals is very humane regardless of how you do it.  Certainly it's kinder to raise chickens in on a free range farm and slaughter them as quickly and painlessly as possible - but you are still killing them, so while it may be "more humane" it's still cruel, in my opinion.  I buy raw milk from a local farm, which I believe is much more humane than milk from factory farms, but there are still a lot of ethical issues involved and I do believe it would be much kinder to just not drink milk.  However, I really like dairy products and they do make it much easier to get my protein in (the amount of protein I believe I need in order to be healthy) so it's a compromise I make for now that i feel I can live with. 

I think the antibiotics and hormones in milk are really unhealthy and that's another reason I get milk where I do - I definitely don't want to be putting that stuff in my body.  It has also been very interesting to me to learn from the farmer I get milk from about how he handles the milk to make sure it's safe even though it's not pasteurized - and by comparison, how likely the pasteurized milk you buy at the grocery store is to make you sick.  For instance, he told me the USDA says farmers must refrigerate milk within two hours of when it comes out of the cow.  Can you imagine leaving milk sit for two hours in at room temperature, then drinking it?  Especially when room temperature is a hot barn in the summer?  He tells me his milk hits the cooling tank within 15 minutes at most.  But how can milk be good for you to drink if it sits out for two hours in the summer time?

Anyway, I wish I had the chance to talk with him because I really have some questions.  I'm wondering if what is unnecessary or even unhealthy is getting too much protein from any source or getting too much animal protein?  I get about 90 grams of protein a day and that's how much it takes to keep the protein and albumin levels in my blood in the middle of the reference range.  So I really would like to know if he thinks my levels don't really need to be that high or if he just thinks most post ops would not need that much protein to keep their levels that high?  And I think my hair and skin and everything looks just fine, even though I get that much protein.

You don't have a six month follow up appointment?  What about getting labs done?  You can always call your dietician before your next appointment if you have questions.

Stay off the scale.

On average, people lose about half their excess weight in the first six months after surgery.  I don't know how much weight you had to lose to begin with, but at just five months out, 56 lbs is just fine.  The more someone needs to lose, the more pounds the generally lose in the first six months, but it still works out to that 50% average.  What I mean is, someone that only needs to lose 100 lbs altogether, can be expected to lose 50 lbs in the first six months.  But someone that needs to lose 300 lbs could be expected to lose 150 lbs in the first six months.  Yet, both are doing just fine.

So anyway, I think you just need to stick with your plan.  What do your surgeon and dietician recommend?

I would go see a  hematologist if you can.  When you call to make an appointment, I would ask if the doc is familiar with RNY patients.  You may need to tell him things like due to RNY, you have little stomach acid, and let him know what the ASMBS recommends in terms of iron dosages and stuff like that.

Honestly, I think it's a bit rare to have such low ferritin and your total iron not be lower than yours is.  But yeah, 55 is on the low end for total iron, even if your ferritin was great, and it's not great.

I do recommend contacting vitalady, though, for advise as well.  She knows a lot about iron.

325 mg ferrous sulfate only gives you 65 mg elemental iron.  Carbonyl is all elemental iron.  So if you are currently taking 100 mg carbonyl iron, switching to 325 mg ferrous sulfate would actually be reducing your dose quite a bit.

Not only is ferrous sulfate very constipating, you need a lot of stomach acid to break it down for absorption and you don't have a lot of stomach acid anymore.  Carbonyl is absorbed a lot better.

What's your total iron?

I think you have a couple of options right now.

You could switch to heme iron, which is more expensive but supposed to be absorbed better and is not constipating.  I'm not sure what dosage you'd want.  If you contact Michelle (vitalady) at vitalady.com,, you can purchase the heme iron from her and she can advise you about the dose.

If your total iron is low too, I would make an appointment with a hematologist.  You could do that anyway.  A hematologist would probably be able to advise you and can also do iron infusions if necessary (IV iron).

Reactive hypoglycemia seems to be very common after RNY and I'm sorry your doctor and dietician laughed at your concerns.  Personally, I would find other health care providers that take my concerns seriously, whatever they are.  Now, most folks I know are able to control their RH with diet but if you can't control yours now with diet, it may be more difficult to do so after surgery.  I would consider consulting with another dietician (one that doesn't laugh at patient's concerns) to see if you can get it under control with diet, but if you can't, you might want to consult an endocrinologist.

Are far as the liquid diet, most doctors don't recommend clear liquids for two weeks, but if yours does, then you could use a clear protein drink like Isopure or Cytomax.  That's what I would do if I had to do clear liquids for 48 hours for a colonoscopy or something.  Most often the two week liquid diet is full liquids, in which case you can choose from a wide range of protein shakes.