I'll start with a disclaimer of sorts...

1.  I am very anal about my vitamins.

2.  I want to try to avoid any deficiencies and would rather take a bit much then too little.  Of course, this isn't true of the vitamins that could cause problems if you take too much - fat soluable ones, iron, etc.

3.  I have belonged to post-op Yahoogroups on long-term grads, vitamins, nutrition and protein.  I read.  I listen.  I ask question.  I have read a ton from long-term post-ops like Michelle (vitalady) and Julia Zubro (now has a new last name) and take what they have to say with great interest and seriousness.

What I take and why:

Multi-vitamins: 2 Multis Capsules (Twinlab Daily One)

I used to take Kirkland Childrens Chewables, then Centrum Silver Chewables and now take Twinlab Daily One Caps which is a capsule.  Since I was hospitalized with chest pains in June which were esophagael spasms... I switched to capsule forms of whatever I could. 

Warning:  Children's vitamins often lack certain things like Vitamin K (which is not potassium), selenium, zinc, etc.

B-Complex:  2 B-100 Capsules (Vitamin Shoppe)

Initially, I was put on 1/4 of a B1 tablet for the first month post-op.  Then after that, we were put on 1 B-Complex a day.  Those are usually the equivalent of a B-50 Complex.  I eventually upped that to a B-100 Complex thinking more was better.  I was having some neuropathy issues in toes and fingers.  My doctor tested some of my vitamin levels but not all.  To be safe, I upped this to two per day and symptoms are gone.  Anyway, we were taking CVS' B-50 and the B-100 Complexes.  They can be broken into 2 using your fingers but are still big.  With the esophagael spasms from my pill taking, I switched to the Vitamin Shoppe Capsules which for me go down well with warm liquids.

Warning:  Some surgeon's do not put their patients on a B-Complex post-op.  This is completely wrong.  I know one post-op who ended up with a B1/thiamine deficiency within 6 months of surgery.  She suffered a stroke and malnutrition.  This is called beri beri.  This could probably have been prevented by 1 additional vitamin each day.  That's all.

Warning:  There are some B-Complex sublingual liquids out there.  Be careful!  For some reason, some of them DO NOT include B1.  Read the label! 

Vitamin B-12:  2 2500 mcg B12 Sublingual Tablets (Rexall bought at WalMart)

I started off at 500 mcg 3 times a week or whatever they told me to take and doing my reading... I realized I'd rather take more than less.  Went to 500 mcg a day.  Then we bought stronger ones... 2500 mcg.  My labs were good on those... above the normal range which is fine according to my doctor "Your B12 is high but we LIKE it high."  Then I noticed that it dropped to just above normal range, so I added a second one each day.  My labs are now very high... above what they measure.  I'll leave it alone.

Vitamin C: 2 500 mg Vitamin C Chewable Tablets (Kirkland bought at Costco)

I take these with my iron.  Will discuss later.

Vitamin D: 3 400 iu Vitamin D Dry Capsules (Vitamin Shoppe)

I was not put on extra Vitamin D initially but from my reading I added 1 capsule a day since I knew it was important for calcium intake and bone health.  My labs had mine in the 20s which is technically normal but low normal.  I read that it wasn't good enough for proper bone health so I upped it to 2 capsules a day.  Then the nutritionists at my hospital told our support group that they wanted our blood levels over 40.  Mine wasn't there so I spoke to my doctor about upping my dose or doing a megadose for a short while to get levels up since sometimes getting them up can be hard.  She tested me again and since upping to the 2nd capsule, I was now at 44 and she was happy.  I did some reading on the vitamindcounsel.com and they recommend a minimum level of 50 so I added one more capsule so I'm doing 1200 ius a day.  When we run out of these capsules I'll probably look for a 1000 iu capsule if possible.

Important info:  Especially if you are a distal surgery, you need DRY vitamin D.  Vitamins in oil bases (gel caps) are in fat.  Post-op malabsorb fats so overall it is better for all of us to avoid gel caps where possible and take vitamins in the dry form.  I'd rather take something that I have a better chance of absorbing.

Vitamin E: 1 400 iu Vitamin E Dry Capsules (Vitamin Shoppe)

Didn't need this based on labs.  Just added this in for cardiovascular and joint health since it is a good anti-oxidant.

Again: I take the dry form.

Vitamin K:  1/2 of a 100 mcg Vitamin K Tablet (GNC) 

Mainly added it because my children's vitamins early on didn't have any Vitamin K.  Nutritionists at my hospital told us that chidren's vitamins didn't have it.  It is good for clotting.

Make folks think that Vitamin K is potassium.  Actually, the symbol on the periodic table for Potassium is the letter K.  That's why there is often confusion.  They are 2 different things.  Vitamin K is important for blood clotting.  Potassium does other things. 

Calcium:  4 500 mg scoops Calcium Citrate (UpCal D powder bought from vitalady.com)

I take 2000 mg a day.  I take 500 mg at a time and spread it out with a few hours inbetween.  I use the UpCal D powder.  The jar is 277 doses for about $20-25.  It is tasteless.  I put a scoop in a protein shake or in a bottle of Propel.  It doesn't really dissolve so you have to shake it up as you go along but it is an easy want to get your calcium without chalky pills to swallow or big pills.  I started early post-op taking Twinlab Chewable Calcium Citrate Wafers - kinda like chalky sweet tarts - 2 were 500 mg.  Hubby takes some of the UpCal D and takes some of the Citracal Petite pills - 2 of which are 400 mg - be careful - many folks think 1 pill is 400 mg.  Read the label!

Important information: As it relates to things like calcium and iron, the mgs listed on the bottle may include the binder... the gluconate, fumerate, sulfate, carbonate or citrate.  You have to read labels carefully to determine how much calcium or iron you are really getting.  This is called elemental calcium or elemental iron.  If the bottle doesn't say elemental iron, sometimes you have to infer what it is.  For calcium, the RDA is 1000 mg for a non-op and the percentage on the bottle is based on 1000 mg.  If the bottle says 500 mg calcium citrate but the label says 40% of the RDA, then only 400 mg of it are calcium and the other 100 mg is the citrate.  If the bottle says 500 mg calcium citrate but the label says 50% of the RDA, then all of the 500 mg of it are calcium.

Iron:  8 25 mg Carbonyl Iron Tablets (Tender-Iron bought from vitalady.com)

My nutritionists had me on iron from day one.  Not all nutritionists/surgeons do that.  Cannot say I understand that.  I was on Vitron C from about 1 month post-op on (before that did a chewable iron) which is ferrous gluconate.  Each Vitron C is 66 mg of elemental iron.  I upped that to 2 per day a few months post-op so I was getting 132 mg of elemental iron.  But as time went on, I noticed a trend... my iron was going down.  I switched to Vitalady's Tender-Iron and took 6 which was the equivalend of 150 mg of elemental iron and then upped it to 8 which is what I take now.  So, I take 200 mg of elemental iron.  My labs have greatly improved.  I split the dose and take 4 at a time with one 500 mg vitamin C tablet.  The Tender-Irons are not labelled as chewable but they are soft and do not have a horrid taste.  So I chew them with my Vitamin C and all I really taste is the C.

Important information: You do not want to take ferrous sulfate if you can help it.  Often surgeon's/PCP's prescribe this.  It is a known gastro-intestinal irritant and in the doses we often need to take, it would be worse.  Better forms of iron for post-ops are: ferrous gluconate, ferrous fumerate, carbonyl iron or polysacchride iron.

Magnesium: 3 160 mg Magnesium Citrate Capsules (Vitamin Shoppe)

I take magnesium capsules to help with the constipation that the calcium citrate causes.  You take a magnesium each day and see if it helps.  If your bowels are too loose, reduce it by one pill.  You have to see how many works for you.  I do well with 3 a day of these.  Some folks need up to 1000 mg (half of their calcium intake) to stay regular.

Milk Thistle: 6 175 mg Milk Thistle Capsules (Spring Valley)

I take this to help cleanse my liver.  I had elevated liver enyzmes since about 6 months post-op and this seems to help.  I had another brand which was a higher dose.  Didn't realize these were less and was only taking 2 and my labs have gone up again.  Was taking 1000 mg a day of the others and that seemed to work well for me.  Just upped these to 1000 mg equivalent and will see if my labs improve.  I'll switch back to 2 of the 600 mg ones when these run out.

Selenium:  1 200 mcg Selenium Tablet (Schiff bought at Costco)

Was deficient in this on one of my labs.  My doctor knew to test for this.  Go figure.  Needed to be added because my children's vitamins early on didn't have any selenium.

Zinc:  1 50 mg Chelated Zinc  Tablet (Puritan's Price bought from vitalady.com)

Good for hair and nail.  Mainly added it because my children's vitamins early on didn't have any zinc.

I think that's it.  Isn't it enough?????