Roux-en-Y Gastric Bypass

Question
Dr Pilcher - I had my surgery in Aug/04.  Over the course of the past 6-9 months I have become iron deficient to the point of IV iron - however had a course of two infusions in Oct/10 and as of last week - still doing OK for now.  My question is this:
I have recently been treated for H-Pylori and am suffering from ITP which we are just starting treatment on.  Bone marrow biopsy - no cancer, etc.  Also 6 1/2 hrs of MRIs due to severe edema from my thighs down to my toes.  Organs normal - however bloodwork showed extreme protein deficiency.  I will be the first to say that I probably do not intake enough protein - however - I find it hard to believe that it might be possible that I am no longer absorbing protein?  Is this something that happens in even a small percentage of gastric bypass patients?  and if so - am I correct in thinking that the only way this can be resolved is to "undo" the surgery?  That fact does not bother me - I know that in the past seven years my eating habits, etc have changed to the point that I am not afraid that I would ever balloon back up to around 300 lbs.  But with the severe edema - I can barely walk much less exercise and am constantly fatigued.  I have been trying to intake at least 70 grams of protein a day as well as 64 oz of water in addition to everything else I drink - such as 1-2 cups of coffee, a diet soda or two.  In addition at least 12-24 oz of fluid is in the form of a protein as I cannot eat that much meat, cheese, or eggs :).

I appreciate your time and do not regret having the surgery (by Dr Stegemann :)).  I just need to find out my options as my quality of life is not too great right now.

Thanks again Dr Pilcher -

Patricia

Answer
Patricia,
I would not rule out a "reversal" of the gastric bypass and that is a technically feasible procedure (though somewhat difficult and risk), but reversal would not be my first move in a case like yours.

The most likely thing is that you are absorbing protein normally, but that over years you have taken in just a bit too little on a daily basis.  Over time, a small daily deficiency could lead to a significant protein/nutritional deficit.  It should be possible to make up this deficit by changing your pattern of food intake, but I think it is going to be very important to be sure you are followed closely by a knowledgeable clinician to be sure you are making progress.  If you do not make progress then it might be necessary to supplement you for a while with IV nutrition.  (These initial maneuvers to improve your nutrition would be necessary even if the eventual goal is to reverse the gastric bypass.)

My recommendation for you at this time is to call our office at 210-614-9210 and make an appointment with Dr. Brian Sabowitz.  He is the bariatrician in our practice, which means he is the expert on all things nutritional other than the actual surgery.  Dr. Sabowitz understands gastric bypass, and he will be able to work with you to maximize your protein intake while preventing long term weight regain.

A reasonable alternative would be for you to get re-engaged with Dr. Stegemann and the medical doc who is working with him.  I'm sure you heard he was moving to St Louis and he did depart New Dimensions with that in mind, but apparently had second thoughts about leaving San Antonio and so he joined the practice of Dr. Sonny Cavazos based out of NE Baptist hospital.  The medical doc in that practice is named Dr. Monica Anz-Cavazos, and the office number is 210-651-0303.

Best wishes!
Dr JP

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