11 yrs post RNY problems

Question
QUESTION: Hi, I am a 41 year old female. I have a question, but let me give you some
backround..
I had a gastric bypass surgery 10 years ago. I am currently having lots of
problems with my blood work. my recent workup showed very low RBC low WBC low
b-12. Blood workup results:
sodium 138
carbon dioxide 21
calcium 8.9
wbc 3.9
rbc 3.7
hemoglobin 8.4
hematocrit 25.9
mcv 68.5
mch 22.2
mchc 32.4  (32.0 being low)
rdw 17.5
platlet count 184
monocytes 261  (200-950)
eosinophils 8
basophils 27  (0-200)
neutrophils 65.5
lymphocytes 26.9
platlet estimation says adequate ** evaluate with caution. the white blood count and platlet count may be altered due to interference caused by the presence of significant numbers of large/giant platlets.

Anti-streptolysin 0  390
ANA screen negative cyclic citrullinated peptide  negative
C reactive protein < 0.40
TSH   1.74
My vitamin regamin was changed, and I am due to go back to have it checked I am feeling less fatigued
I had a cervical fusion at c4,5,6 4 years ago. I have a thoracic
Hern disc and at last lumbar-S-1. DDD with stenosis the normal curve in my neck
is I am told not there. I have heart palpitations and very radome low BP or high
BP. Normal EKG test. OK so my symptoms that I am writing to you are...

Cold fingers, not all at the same time sometimes its one hand index and middle
fingers will be ICE cold to the touch and feeling. but the pinky and ring
fingers will be warm. This comes and goes. My feet and mostly toes on both feet
are often ice cold, no matter what I do, then at night they my legs will ache
terrible, the only way I can describe it is that my BONES ache, not muscle. Intermittent change in TASTE, constant taste of BILE or sour in my mouth. worse with eating. NOT like acid reflux at all.
I also have developed very very poor short term memory, bouts of extreme leg weakness that comes on with lifting anything that seems to creep up, become to much to bear and then goes away, and approx 9 months ago I had several nights where I lost my bowels while sleeping. this happened three or four times then
stopped. I was not ill at the time, and it was not dumping syndrome. Gall bladder flare ups. constipation or diarrhea. I have seen a neurologist and a neurosurgeon recently, I was tested for thyroid problems,
MS, Cancer, Rheumatoid arthritis and lupus. All were negative, thank god. I had an MRI on my brain, neck and cervical spine, and was told that although I do
have some issues with my spine that it was nothing that they felt would be contributing to my symptoms. I feel like the doctors have given up. I believe
that a NCS and EMG should have been done, and I am wondering if the entire thing is nutritional, and the vitamin def has caused nerve damage like neuropathy or a
myopathy? Any thoughts???? I am at a loss. The symptom of most concern to me right now is the leg pain, my feet either being ice cold or hot like fire, and half of my fingers becoming ice cold.  
My RNY Dr. is in another state, should I find another one, was the neurologist not the type of Dr that I should have seen? My family Dr has no clue, the neurologist is looking for nerve things, and the neurosurgeon is looking at my back, I am thinking that perhaps a bariatric Dr with a lot of experience in nutritional deficiency might be who I need to see. HELP!




ANSWER: Dear Kelly,

Often, when I get an email like this through About.com, I would check the option that allows me to tell you that this question is too complex to answered through the internet.  And truly, it is.  For me, it raises as more questions than answers.

This said, I can hear your fear and desperation and I don't want to leave you hanging with improper guidance.  Being so far out from your surgery and far (in distance) from your surgical program makes matters worse.  Here is what I suggest.  I most likely can be of much more help to your physician than to you directly.  I do many consults with doctors, I don't charge for that, and I think I could probably help point your doctor to some things to investigate.  While this might not be a nutritional problem at all, it could be -and there are risks that arise many years after surgery that are not likely to be obvious even to a good general practitioner.

My office email is [email protected]
Please have your doctor get in touch with me.  If he/she won't do this, let me know.

I also strongly suggest that you copy the email you sent to me and send it to your bariatric surgeon.  Though you live far away, it is likely that your surgeon could have valuable input - or at least might want to be apprised of a potential long-term complication of your surgery.

Does to seem like a reasonable place to start?
Let me know.

In Health,

Dr. Jacques

---------- FOLLOW-UP ----------

QUESTION: Thank you so very much. while I am not actually fearful, I am just frustrated. I just didn't know where to go now, but your suggestion and offer of assistance to the bariatric Dr. is great. Thank you so very much. The reason I went to see the neurologist in the first place is that I really think that I have been so b-12 and iron def for so long that I have developed some nerve damage as a result, and I wanted to know how bad, and if it could be stopped. Anyway thanks again and I will do what you have suggested.

Answer
Kelly,

I am really very happy to help.  The bone pain you describe should be investigated separately, and there are some other things the neurologist may not think to look at.  So see if they will be in touch with me.  If not, as I said, let me know and we'll go from there.

In health,

Dr. Jacques

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