How does the lack of calcium cause bone spurs?

When I first heard I had a bone spur in my heel, the doctor told me it was a lack of calcium that caused them.  When I told other people that, they laughed at me.  Things don't GROW on your body when you LACK other things, silly girl.  So, then I thought maybe I misunderstood and bone spurs were from EXTRA calcium, so I did a little research.  

As many of you know, I had surgery to deal with my bone spur.  I am at four months out.  There has been little change since my three-month update.  My "good" foot hurts almost daily and my "bad" foot doesn't hurt much but is still swollen.  I am back to working out five to six days a week.  I have again recently confirmed with my doctor that bone spurs are from a lack of calcium, not an abundance of it.  So I decided to do a little more research (and by "research," I just mean I "Googled" it) to find out how bone spurs are formed.

Ice and rest after over-doing it

My assumption was that bone spurs were caused when calcium was somehow leeched out of the bones and then re-deposited when it had nowhere else to go.  I don't believe that is fully true, but the truth may not be so far from that.  Here is one explanation: 

"A heel spur is a hook of bone that forms on the heel bone, an X-ray will show a point of bone protruding from the bottom of the foot at the point where the plantar fascia is attached to the heel bone. The heel spur itself is not thought to be the primary cause of pain, rather inflammation and irritation of the plantar fascia is thought to be the primary problem cause by the tearing of the micro ligamentous tissue from the heal bone. The heel spur then forms because the body is trying to heal itself and has calcium deficiency. After the heel spur is formed and stress is placed on the plantar fascia from walking the heel spur just adds to the irritation and inflammation."

More interesting information:

"Researchers located the root cause. They found that calcium deposits are most common in women aged 35 to 65 – the group most prone to osteoporosis. Knowing that osteoporosis is primarily caused by calcium and mineral deficiency, they realized that two conditions share one cause.  Calcium and minerals are needed for every vital function of your body, from the pumping of your heart to cell division to DNA replication. If you’re not ingesting enough calcium to fuel these functions, your body robs your bones! This survival mechanism is the acknowledged root of osteoporosis, and now we know it causes bone spurs, too."

"Bone spurs are your body's cry for calcium and minerals. Ignore it – and you may become a prime candidate for osteoporosis, heart disease, cancer, arthritis, and more than 160 other degenerative diseases related to mineral deficiencies!" 

Information about absorption of calcium (and I don't know how to adjust for gastric bypass patients, but I assume we absorb even less):

The exercises and stretches help a lot

"Calcium is the most abundant mineral in the body, but it may also be severely lacking. The amount of calcium that we absorb from our food varies widely. One factor that affects this is age. An adolescent may absorb up to 75% of the calcium obtained from foods, while in adults the maximum absorption rate ranges from 20% to 30%. Even though our bones feel solid and seem permanent, they're just like any other body tissue - they're constantly being broken down and formed again. In an adult, 20% of bone calcium is withdrawn from bones and replaced each year. Thus, every five years the bones are renewed."

So there you go.  Bone spurs are most definitely caused by a lack of calcium, AND it appears that I may be at higher risk for osteoporosis.  I get blood tests every year and I don't believe my labs have come back showing I was lacking in calcium, so I'm not sure if the test is flawed or if my body needs more calcium than the average person.  That's a whole other issue I'm not prepared to deal with.  I remember being told not to "worry" about osteoporosis because fat people don't get it....frail old white ladies get it (I believe I was told this by my previous (two doctors ago) tiny Asian lady doctor, who gave me bad medical advice on many, many occasions).  Apparently all the weight my body bears just walking around on a daily basis is literally saving it from ever getting osteoporosis.  I'm not really sure that's actually true, although perhaps it is somewhat more helpful than being tiny.  

It does seem like the exercising I am doing is probably the best thing I can do for myself.  Yoga, spin and pole appear to be great exercises for strengthening the body and the bones.   

What old wives' tales were you told that you believed, just because you didn't know better?  How did you find out it might be wrong? 

Vitamins after Gastric Bypass

This was my first year (at nine years post-op) not being deficient in some vitamin or another.  I definitely have a crazy vitamin regiment.  I wanted to pull all of my vitamin related posts into one.  So here we go:

April 2011:  http://lolorashel.blogspot.com/2011/04/vitamins-and-gastric-bypass-surgery.html

November 2011 (guest post):  http://lolorashel.blogspot.com/2011/11/taking-care-of-ourselves-in-gastric.html

January 2013:  http://lolorashel.blogspot.com/2013/01/pole-sweat-and-magnesium.html

March 2013:  http://lolorashel.blogspot.com/2013/03/bone-spurs-calcium-heart-attacks-and.html

March 2013:  http://lolorashel.blogspot.com/2013/03/update-vitamins-and-gastric-bypass.html

March 2013:  http://lolorashel.blogspot.com/2013/03/malabsorption-after-gastric-bypass.html

March 2013:  http://lolorashel.blogspot.com/2013/03/vitamin-d3-dry-and-gastric-bypass.html

April 2013:  http://lolorashel.blogspot.com/2013/04/vitamin-d-and-sun.html

Here's a photo of the vitamins I take everyday and I'm actually light a few pills...need to get to the store soon

Vitamin D and the Sun

I am a child of the summer.  I was born on August 31...right at the end of summer, and usually during the hottest part of the season.  If I could live my life in a bathing suit and flip flops, I would.  Yeah, I know, I should be worried about skin cancer.  But I remember being a kid and having the outline of my swimsuit suntanned into my skin well into winter time.  I miss those days.

Now that I've had gastric bypass, one of the vitamins I seem to be deficient in is Vitamin D.  That comes from the sun, right?!  I definitely struggle in the winter without my sun.  I also struggle now that I'm an adult that has to go to a job all day, every day and I get much less time to lay around by the water, relaxing and soaking up the rays. 

I have often justified going to tanning booths to help with my psoriasis.  Studies show that some of the beds aren't the same as the sun when it comes to helping kill psoriasis (the funny thing is, the doctor's offices DO offer a certain type of tanning bed but it is generally NOT the same one in your run of the mill tanning salon), but the real reason I was going was for the brown skin.  Yeah, I'm sure, I'm dealing with wrinkles and all that, but I do love being tan. 

A couple of years ago, I decided that since I was in my mid-30's, I should be taking better care of my skin.  No more tanning.  I now look like a vampire.  In fact, when we go to Disneyland and the rides take photos of us, you usually can't see my nose or mouth because I am SO white.  There has to be some middle ground.

I wrote about Vitamin D recently and wondered how much sun you "need" to get enough Vitamin D the natural way.  And so, as per my usual protocol, I Googled it.  I love Google...that bitch knows EVERYTHING. 

http://nutrition.about.com/od/askyournutritionist/f/sunlight.htm

Your body makes vitamin D when your skin is exposed to the ultraviolet B (UVB) rays in sunlight. You probably need from 5 to 30 minutes of exposure to the skin on your face, arms, back or legs (without sunscreen) two times every week.

http://www.drweil.com/drw/u/QAA400732/How-Much-Sun-Exposure-for-Vitamin-D.html

Dr. Holick advises estimating the time it would take your skin to turn pink in the sun. Then divide that time by 25 to 50 percent, depending on your skin type. So, someone like you who has fair skin, burns easily and lives in Pennsylvania would be advised to spend 20-30 minutes in the sun with your arms and legs exposed (not your face) between the hours of 11 a.m. and 3 p.m. two to three times a week from March through May and September through October but only 15-20 minutes in July and August when the sun in strongest. If you remain outdoors longer than the specified time, apply sunscreen. (Don't even try to get sun time from November through February; in your area, you won't get enough UV to help, and you'll probably get pretty cold outside with bare arms and legs.)

http://www.shanghaiexpat.com/article/vitamin-d-and-sun-exposure-20667.html

Given that there is a matrix of variables that need to be considered, it is impossible to prescribe a one-size-fits-all guideline that would balance the sun exposure needs versus risks for all people. However, because there are diseases related to both insufficient and excessive exposure, it is important for each of us to get a sense of how much sun our skin needs to produce adequate amounts of vitamin D without increasing the risk for skin cancer.

So, it appears that I can get my Vitamin D from the sun but I will probably have to continue my Vitamin D3/dry supplements, as I am probably not going to be able to increase my time in the sun any time soon.  I have started back to the tanning beds, but only once a week.  I don't do that for the vitamins or my psoriasis.  I just do that because it makes me happy.  And sometimes you have to do that for yourself. 

Tan and in Mexico in 2007

Pale in 2012

Vitamin D3 (dry) and Gastric Bypass

Yesterday, I updated my vitamin list and today, I wanted to talk about why Vitamin D dry (or at least a non-softgel) is a better fit for gastric bypass patients.  We are malabsorptive in general of vitamins and nutrients after our intestines are re-routed, so certain vitamins don't absorb as well as others.  That includes Vitamin D in a softgel. 

I found a link comparing various Vitamin D supplements for gastric bypass patients.  Why re-invent the wheel?  Check out that article HERE. 

The American Society for Metabolic and Bariatric Surgery points out that gastric bypass patients are at greater risk for vitamin D deficiency due to having part of their small intestine bypassed. They should get regular blood tests to monitor their vitamin D levels and supplement as necessary.

Linus Pauling Institute explains that D3 is absorbed best by everyone, including but not limited to gastric bypass patients.

...softgels filled with oil ... don't work well for gastric bypass patients since they malabsorb fats.

And from the ThinnerTimes forum, read the entire post HERE.

50,000IU gelcaps of vitamin D are always D2 (Ergocalciferol).

We absorb the dry form D3 (Cholecalciferol) far better. D3 is the human form; D2 is the non-human form found in plants and is cheaper!

But apart from that, people with malabsorptive procedures absorb the dry forms of the fat soluable vitamins A, C, D and E over the oil based supplements.

Regarding vitamin D, this is from the American Journal of Clinical Nutrition: The case against ergocalciferol (vitamin D2) as a vitamin supplement -- Houghton and Vieth 84 (4): 694 -- American Journal of Clinical Nutrition

The top two bariatric supplement companies: Celebrate and Bariatric Advantage only use D3 (Cholecalciferol).

The cheapest 50,000IU dry form D3 I know of is from vitalady - $21.49/100 tabs: Vitalady.com - Protein Supplements, Vitamins & Minerals and Safe Snacks!

So, there you go.  Sounds like dry Vitamin D3 is our best option for absorption.  What I need to research next is whether sitting in the sun is as effective or better than taking a supplement.  I'm always looking for reasons to get a little extra sunlight. 

Does anyone else have anything to add to this?  I had to add Vitamin D into my vitamin regimin two or three years ago.  I was low and my doctor said to add it in.  My levels are back to normal but I still take a dry D3 every day. 

Update: Vitamins and Gastric Bypass

In 2011, I wrote a post about the vitamins I take.  Although I mostly take the same vitamins (so you can read the old post HERE about why I take them), I wanted to post an update to types and amounts. 

I still take a Target/generic brand prenatal pill as my multi-vitamin.

I, for a short time, started taking iron due to slight anemia last year, but am back to normal and have discontinued taking iron.

I also still take echinacea.  Who knows if it works, but I take an immuno-suppressant to help with my psoriasis and I feel like any help I can get to ward away colds is a necessary evil.  The Stelara shot suppresses my immune system and can make me stay sick longer.  So I try to avoid getting sick.

I also still take a daily dose of L-Lysine (1,000 mg) to ward off cold sores.  Since I have a stressful job, keeping those at bay is one of my number one concerns.  I know it seems silly, but I REALLY hate cold sores.

I have been lax on the acidophilus.  It's in my fridge.  I kind of forget about it. 

I take B12 daily.  1,000 mcg.  Post-surgery instructions suggested twice a week, but I figure it can't hurt to take it more often. 

Even though I find myself to be a bit sensitive to niacin (B3), I am back to taking a B-complex vitamin.  I was low in B1 awhile back, so its one of those vitamins that I need to take.  Sometimes if I'm vitamin shopping at somewhere like Target, I can't find B1 alone, so I'll just lazily grab a B-complex.

I also take calcium-citrate (500 mg) with Vitamin D and Magnesium.  Read HERE about calcium.

I still take a Vitamin D3 (2,000 IU) pill, but have switched to the "dry" version.  Most Vitamin D pills are oily capsules that look like mini Vitamin E's.  Apparently gastric bypass patients can have a hard time absorbing those (I'm hoping to write a post about that soon). 

I still take a Vitamin E dl-alpha (400 IU) pill.  It is an oily capsule, so who knows if I am absorbing it properly.

I have stopped taking the joint supplement.  It's expensive and I'm not sure it was helping that much.

I am still taking an omega-three supplement.  I have switched from regular fish oil to krill oil.  It contains 420 mg of Phospholipids.  The switch is due to my newly-found heart issue (I was also informed that my new issue is not necessarily related to my old issue....I now have an inflamed heart.  Before I had an enlarged heart.).  Anyway, the krill oil is supposed to help with inflammation.

I have added magnesium to the mix (250 mg each...but I take two to three per day).  You can read about my adventures with magnesium and sweat HERE.

I also added 50 mg of zinc and a CoQ10 supplement (100 mg).  I try to remember to take a little Vitamin C from time to time as well. 

I basically take my cache of pills and eat them at work with dried apricots and almonds or pistachios (I do not take most vitamins on the weekend).  Some vitamins are fat-soluble so eating a little fat with them will help with absorption.  Along with everything else, I'm taking a daily baby aspirin for the heart issue and take Aleve for body aches -- mostly my foot issue (yes, I am aware I shouldn't take either).  I rarely get headaches but will take Tylenol for that.  I take allergy pills for my year-round "seasonal" allergies. 

Vitamins are VERY important post-surgery.  (Read Melissa's story HERE.)  I am nine years post-op and still get my blood tested every year.  Every year I'm low in something new.  I am hoping to be in normal ranges for all tests this year.  I am certainly taking more than enough pills to make that happen!

What vitamins are you taking and are there some you think you should be taking but aren't?  Tell me about them here!

Malabsorption after Gastric Bypass Surgery

So in one of our support group meetings, one of our more knowledgeable members mentioned that gastric bypass patients are only malabsorptive in the calorie department for a year or so after surgery.  The body apparently has an amazing ability to adapt and the lower intestine will "re-grow" villi.  Funny that we seem to gain back the ability to absorb calories, but not necessarily the ability to absorb nutrients. 

Anyway, I went on the hunt for some information.  I had a hard time really finding anything concrete.  I see message boards were people are asking and answering questions, but not much "real" authority.  Here's some of what I found:

http://care.diabetesjournals.org/content/28/2/481.full

Protein deficiency is easy to recognize by following albumin. Fat malabsorption manifests its presence by loss of fat-soluble vitamins. Patients can present with a number of problems after this procedure. In our clinic, the most common presenting complaint is fractured bones or a bone density study showing “severe bone loss.” Due to fat malabsorption, severe vitamin D deficiency will develop along with an already reduced ability to absorb calcium (23).

                

In general, fat-soluble vitamins A, D, and K will be deficient in two-thirds of these patients within 4 years after surgery. Up to 50% will have hypocalcemia, and all of these patients with low vitamin D levels will have secondary hyperparathyroidism (24,25).

                

Manifestations of all the different fat-soluble vitamins can be seen, ranging from unusual rashes, to osteomalacia, to easy bruising. Fortunately, there is a rather simple solution: pancreatic enzyme replacement. When pancreatic enzymes are replaced, there is some weight regain, and physicians often observe patient noncompliance as a result. The hyperparathyroidism may be difficult to treat and may require separate treatment or even surgery.

                

Other problems associated with this type of procedure include severe hair loss, liver disease (usually transient), kidney disease, and unusual body odors (26). The lifestyle after this procedure can be difficult due to the frequent bowel movements (over 10 times a day) and the foul-smelling stool that the fat malabsorption causes.

http://www.obesityhelp.com/forums/rny/4253502/Malabsorption-How-long-does-it-last/

No one knows for sure; each person has their own experiences. However, since weight loss tends to slow for most around the 18 month mark, that is a safe benchmark I suppose.

*****

Studies on this topic are mostly done on patients who had cancer or some other form of a diseased intestinal tract and had to have a portion of their intestines removed to save their lives. The body is pretty amazing and can "heal" itself to a certain extent. The micro-nutrient malabsorption (vitamins/minerals) will never fully repair, but the macro-nutrient (calories/protein/fat/carbs) malabsorption will eventually be repairs completely. This process is called adaptation.

From what I've read, it looks like the adaptation process begins almost immediately after surgery - within 4 days. But it can take up to 2 or 3 years to complete depending on your body and how much was bypassed. The remaining intestine will grow longer and stronger and more dense villi - the little finger-like tentacles that grab nutrients from food as it brushes by. It's also called the brush border. But since vitamins/minerals have assigned locations of absorption, no amount of extra villi will make us absorb vitamins that had their assigned location bypassed. Here's a diagram [note: link no longer valid] that explains those locations.

For more reading about Adaptation. Here's some links: http://www3.interscience.wiley.com/journal/122341206/abstract http://www.springerlink.com/content/m6h3622488510617/ http://jn.nutrition.org/cgi/content/full/133/11/3703

This doctor claims that there is no caloric malabsorption at all:  http://www.thinnertimesforum.com/topic/59658-calories-in-normal-stomach-vs-gastric-bypass-stomach/?p=730692

Your food is absorbed by your small intestine. The stomach churns up your food, and the stomach juices start the digestive process. After a gastric bypass you will probably still absorb 100% of the calories that your eat. There is less absorption of B12 and Iron, possibly of Calcium, but unfortunately not of calories.

http://www.thinnertimesforum.com/topic/59753-no-calorie-malabsorption/

Web MD: "Gastric bypass
Gastric bypass surgery makes the stomach smaller and allows food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size, which reduces the amount of food you eat and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

Medline Plus: "Your diet after gastric bypass surgeryURL of this page: http://www.nlm.nih.g...ions/000173.htm
You had gastric bypass surgery. This surgery made your stomach smaller by closing off most of your stomach with staples. It changed the way your body handles the food you eat. You will eat less food, and your body will not absorb all the calories from the food you eat.

Laproscopic MD: "This technique is called a roux-en-Y intestinal bypass. Once in place, food passes from the stomach pouch directly into the jejunum, bypassing the duodenum. Because of this bypass, there is reduced absorption of calories and nutrients.

ASMBS association says "Treatment of morbid obesity and obesity related disease and condition: limits the amount of food the stomach can hold and/or limits the amount of calories absorbed.

*****

Any malabsorption from calories wouldn't last for long anyway.

The body is a miraculous thing and our intestines grow additional villi to compensate for the RYN's bypass. Villi are finger-like projections in the small intestine that help absorb food more efficiently in the body.

*****

At a recent follow up I asked my doctor about villi regrowth and she said it doesn't happen. She also said if your tool stops working completely it's due to human error - not measuring or eating the appropriate foods, fluid intake, etc. 

*****

Patients who have had a part of their intestine removed by surgery undergo a process called intestinal adaptation. During intestinal adaptation, the intestine may grow in size after surgery. The surface area inside the intestine increases as the mucosa (lining of the intestine) becomes thicker. The villi (the lining of the intestine responsible for intestinal absorption) become longer and denser, helping to promote absorption of nutrients. The diameter of the intestine may also increase.

Here is a diagram from the posting above, which shows were things are absorbed. 

So according to what I found, you may be malabsorptive for 12, 18 or 24 months, or not at all.  Who knows...but I do know that whether I am absorbing my calories, I do have to be very careful with my vitamins.  I still have my blood labs on a yearly basis and each year I am somewhat deficient in something.  So I just "up" that vitamin and by the next year, I'm good.

Have you ever heard about calorie malabsorption?  If you have links to articles, please post them!

Bone spurs, calcium, heart attacks and gastric bypass

I recently reported that I have a very painful bone spur in my right heel.  It affects me every day.  I have spent a ton of money trying to make this thing right.  I don't know if it ever will be.  I've had two cortisone shots and they only seem to last about three weeks.  I had been told that bone spurs form due to an over-abundance of calcium in your system.  The calcium supposedly doesn't know where to go, so it attaches to your bones.  Apparently this is NOT true.  So I started researching bone spurs and calcium, and that lead to some studies, and my realization that gastric bypass surgery has potentially caused ANOTHER health issue for me. 

I had gastric bypass to AVOID health problems.  I was in my 20's.  I didn't have high blood pressure or diabetes.  I did not yet have ANY of the "fat diseases."  I was just fat.  But I thought I better ward them off by completely rearranging my insides.  Sounds like a great idea. 

My very first issue was waking up with staples holding my guts together.  I had gone to sleep thinking I was going to have laporoscopic surgery.  The intestine they had chosen to attach to my new pouch was too short, so they had to open me up at the last minute, leaving me with a much longer recovery than expected. 

My next issue, about nine months out, was blacking out.  My blood pressure and blood sugar would drop so low that I would black out if I stood up too fast.  I literally had to stop reporting it to my doctor because my driver's license was going to be yanked for losing consicousness (even though it never happend when I was just sitting).  I also had to go back to my surgeon and ask for more calories.  Our program told us that every person should eat 1,000 calories per day for life after surgery.  I insisted that since I was six feet tall, perhaps I should get a few more calories than a five foot tall lady.  I was given 1,500.  By the way, 9 years later, I maintain my weight on about 2,300-2,500 calories a day.

I also ran into tons of vitamin deficienies.  Each year was something new.  You want to know how you know you have a B12 deficiency?  The tops of your feet go numb.  Want to know how you know your protein is low?  Your hair falls out. 

Anyway, I don't want to bore you with all of my issues.  But I definitely ended up with more health issues AFTER surgery.  I'm not saying I wouldn't do it again, but it is something to point out...this surgery doesn't fix everything.

Back to the bone spur.  So, the doctor says, hey you have a bone spur, and they take a long time to grow.  At first I was thinking, well maybe I had it when I was even fatter.  But then I realize, I had surgery 9 years ago, and that IS a long time already, so I start researching bone spurs.  According to the Mayo Clinic:

Wear-and-tear arthritis (osteoarthritis) is the most common cause of bone spurs. As osteoarthritis breaks down the cartilage cushioning the ends of your bones, your body attempts to repair the loss by creating bone spurs near the damaged area. The extra bone may help increase the amount of surface area for load bearing.

According to Livestrong.com:

Calcium is essential in the formation of strong and healthy bones as well as in maintaining the health of your bones. According to "The Vitamin Book," a lack of calcium can contribute to the formation of bone spurs by not allowing your bones to form as they should. A lack of calcium can cause your bones to form abnormally, leading to the possible formation of bone spurs.

[emphasis added.]
So, did gastric bypass and vitamin deficiency strike again???  Was I not absorbing my calcium supplements, leaving me at a higher risk for bone spurs?  Who knows, but let's talk about some recent studies about calcium and heart disease, and why we have to be careful about taking TOO MUCH calcium. 

High calcium intake has recently been linked to heart disease in men!  Read the entire article HERE.

Over 12 years of follow-up, men who took more than 1,000 milligrams (mg) of daily supplemental calcium were 20% more likely to succumb to heart disease than those who didn’t take calcium supplements. There was no connection between calcium supplements and heart disease in women (which has been seen in earlier studies), and no connection with calcium from food. The results were published yesterday in JAMA Internal Medicine.

But wait, now there are studies to say calcium can lead to issues for women as well!  Read that article HERE.  They reported that women taking more than 1,400 mg of calcium per day were twice as likely to die as those taking 600 to 999 mg. 

What the studies don't seem to address is whether we are talking about calcium citrate (YES for gastric bypass patients) or calcium carbonate (NO for gastric bypass patients), or whether it matters.  They do both seem to suggest that we are only talking about supplements, and not getting calcium natrually from foods. 

I was recently told I have heart inflammation.  I will be writing about that soon, but I am having to increase my exercise, decrease fatty foods, and take...a baby aspirin (no-no for gastric bypass patients -- again, another planned future blog).  So, in response, I have lowered the amount of calcium supplement that I take (one pill instead of two to three...I'll grab the amounts and publish that new blog soon).  Also, we should be taking Vitamin D with calcium to help with absorption (and if you're a gastric bypass patient, you need the dry version, not those cute little oily pills).  I am also taking zinc and magnesium.  It is, in fact, be time for me to re-write my daily vitamin in-take blog, to let people know what I'm actually taking now. 

Ok, back to this bone spur.  I have heard some home remedies about apple cider vinegar dissolving bone spurs.  I have heard a ton of good things about health and apple cider vinegar, actually.  Some of the reports say you should drink a little bit of cider (I get the organic stuff, not the Heinz bottle) with water.  A bodyworker at Twirly Girls warns to do two weeks on, two weeks off.  So, I have been adding it to my morning glass of water for the last couple of weeks (before breakfast, I try to jump start my metabolism by drinking a glass of water anyway).  Now, other reports say to soak a towel in apple cider vinegar and wear it around all day (although I'm not really interested in having a wet sock all day). 

So, there you have it.  Lack of calcium may have lead to a bone spur in my heel, and trying to take additional calcium to fix it could potentially lead to heart issues.  I guess you can't win.  Has anyone else had any experience with any of these issues? 

Taking care of ourselves in the gastric bypass world

The first real person I knew who had gastric bypass surgery was my friend, Melissa Donald.  This was almost 10 years ago.  Lately, she's been facing some issues and I have asked her to write a guest blog about them as a reminder that, as gastric bypass patients, we always need to remember that we've been altered:

I was always the chubbiest kid in school.  It didn’t really bother me because I was also usually the smartest.  The kids might not want me on their kickball team, but everyone wanted to sit next to me in the classroom.

It was a system that worked for me.

By 2000, I was in my early 30’s, happily married with a great career.  I also weighed about 500lbs.  I did not really have any co-morbidities – no diabetes, no high blood pressure and I had not blown out a knee or my back.  

In July 2002, I started preparing for surgery in earnest.  I switched to a post surgery diet and started losing weight.  I also got my first Cane Corso mastiff as a walking companion.  My first walk with him was to the end of my front lawn before I was out of breath and sore.  I weighed somewhere north of 525lbs.

In January 2003, I had RNY gastric bypass surgery.  I was a poster child for the surgery.  I was ostensibly healthy, I had no side effects, I became obsessed with walking my dog and going to the gym.  I lost 39lbs in the first 13 days after surgery and continued to lose at a great clip for six months.

My body just stopped losing weight at 6 months, even though I continued to shed inches as I exercised more.  My lowest recorded weight was 299.5 lbs.  Given where I had started, I was very pleased with the result.

I never found a supplement/vitamin regime that I could stomach (literally and figuratively).  Pills of any sort make me sick.  Always.  I also didn’t worry about it because my lab work was always well within normal range.

I maintained my weight loss until 2008, when my mom died.  Slowly, my weight crept up – a pound here, a pound there.  In 2009, my 18 year marriage ended and in early 2011, I had to put my dog (exercise companion, best friend) down.

For the first part of 2011, I thought I was in a funk.  I was exhausted, sore, unmotivated, and the weight kept creeping up.  I had gained close to 50 lbs and I did not have the gumption to do anything about it.

In July I finally went in for a routine physical and asked my PCP to call in lab work ahead of time so we could talk about the results at my appointment. The day I did the lab work, I started getting frantic calls from the lab asking me if I was OK and if I needed an ambulance.  It turns out that my blood count was so low (5.9, when low-normal is 11.5) they were sure I was not standing upright.  I spent the next day in the ER getting blood transfusions while everyone fussed around me, determined that I was bleeding internally.  I however, spent my time in the ER with my phone googling reasons for low blood counts.  The light bulb went on that this was all related to my surgery and malabsorption.

I spent the next several months arguing and fighting with doctors who wanted to perform every invasive test possible. Even though I told the doctors that pills of any sort make me sick, their “answer” to my problem was to take toxic levels of iron and feel nauseous all the time) I finally went outside my insurance and paid out of pocket for a holistic doctor who took one look at my test results and said “They did not test for the right things…why is there no test for B-12 or vitamin D?”.

End result…I am severely B-12 and D deficient.  Ironically, this is one of the most common health issues for women in their 40’s AND gastric bypass patients.  It maddens me that given the fact that I am a female gastric bypass patient in my 40’s and it took my diligence (and frankly, fear of needles since they next invasive test scheduled was a bone marrow biopsy), to get to the root of the problem.

I spent three months feeling nauseous and not getting well because the doctors would not listen to me.  Once I was properly diagnosed, I was able to start getting well.

In the last two months, I have had 7 iron infusions and have started a regimen of liquid supplements that 1) taste good and 2) don’t make me sick.  I have gone back to the gym (first time back to the gym I lasted for 7 minutes – I am now up to almost an hour of cardio).  I have lost 14 lbs, the dizzy spells have passed and my blood work is “almost” normal.

So, what is my point, you ask?  Well, whether you have “side effects” while you are still in the hospital or it takes 8 years for them to show up, the health issues WILL present at some time and we must be ready for them.  And,  no one can advocate for us better than we can.  If I had not done my own research, gone outside my insurance, and advocated for what I KNEW the problem was, they would have continued to poke me with needles and do a bunch of testing and I would not be well on my way to good health.  

I will never regret having the surgery.  It quite literally saved my life.  I will also never again be in a situation where I expect some medical book to know more about me than I know myself.  And… if anyone reading this gets  their Vitamin D and B-12 checked and can avoid what I have dealt with, it will be worth it.