Monday, June 22, 2009

Dem Bones, Dem Bones. Dem Frail Bones . . .

I just read this article looking at the connection between bariatric surgery and weakened/thinned bones. Yep. You read it here first . . . gastric bypass might have some negative impact on your body over the long haul. What? That's not NEWS to you? Yeah. Me neither.

Here's the thing. And I won't get my soap box out here - don't fret - but any one who is really ready to enter in to this surgery and this life should be educated enough to enter in. How many times did I hear the lectures about hair falling out and bones suffering and blood clots on the table and after surgery and the need to get moving right after surgery and the potential for long term damages and suffering inside the body based on things the medical community did not yet know about the surgery and its long term impact (we don't know the 50 year implications of a surgery that is not yet that old).

Here's what we're all doing . . . trying to get healthy. We're willing to admit defeat against our bodies and our food impulses. We're willing to accept that the 50 - 84 diets we've all tried in our lifetimes have failed us. We're open to understanding that we need help in a drastic and extreme way. We are all willing to accept the RISKS that go with the surgery positive that the rewards, over the long haul, will outweigh (pun intended, suckahs) the certain struggles and strains and shortened life and crappy quality of life that would come with doing nothing.

My bones might thin out? Okay. No problem there. I'll take my calcium supplements. I'll drink my daily milk. I'll make sure that my protein bars have protein added. I'll get some calcium in any way I can (even though there is plenty of scientific evidence to support that - by 33 - my body has already taken in all the calcium it is willing to take in for bone development). I'll do the proper thing and maintain post-surgery care (physicals, blood screenings, general assessments) every year for the rest of my life. I'll risk my hair falling out (thanks to genetics it is doing that anyway) and I'll risk that my bones might - 50 or 60 years from now - become frail and weak.

Why? I would have had the joint and back pain every day for the rest of my life (just as I did at 530 pounds). and I lived in constant fear of falling down and breaking every bone in my body as a 500 pound man (just ask Wifey about how much of a mess I became one day when I tripped while looking at a house in Maryland). Because, frankly, without this surgery I would not have been alive for those bones to fail me 50 years from now.

The facts and statistics might be compelling (lots of evidence of reduced hip density, broken bones seem to be common, etc.) but I want to know how faithful those people are to their supplements and diets and I want to know what these people were doing that might have risked broken bones (a sidebar - we are a LOT more likely to run, jump, slide, skip, wrestle, sky dive, run, walk or do errands (smile) following our surgery and "stuff" happens when you are suddenly active after years of being sedentary) and I want to know what any of those statistics has to do with the price of tea in China.

I'm not scared. I'm not going to sit down with Wifey this evening and discuss how we'll put MedicAlert in to our monthly budget and I'm not even going to take it easy on the treadmill tonight (God willing I'll run even harder).

If my bones eventually become frail and weak . . . it is the cost of doing business in the GB world. It is the risk for the reward. The yin for the yang. The quid pro the quo. I'll be just fine. And you can sign "I told you so" on my cast(s) if you think I'm a fool for taking this attitude towards the article and the findings!


Syl (previously known as Shib) said...

Just a quick note, even though your bones have taken in all the calcium they can, we need those calcium supplements to ensure that our blood doesn't start pulling calcium out of dem bones to supplement it's loss.

Syl (previously known as Shib) said...

Sorry for the second comment, here's a link to the actual research and what my surgeon ahd sent out to his patients: Dear Valued Customer,

We wanted to let you know about new data presented this week (June 10, 2009) at the annual meeting of the Endocrine Society in Washington DC. Doctors from the Mayo clinic looked at 97 patients from the past 20 years who have had bariatric surgery. They found that 21 of these patients had suffered a total of 31 fractures. Most fractures occurred an average of 7 years after surgery, with the primary locations being in the hands and feet. Other sites of fractures were the hip, spine and upper arm.

There are many risks for fracture in adults including age, gender, ethnicity, smoking and alcohol use, diseases like type 1 diabetes or rheumatoid arthritis, and use of medications such as steroids, antidepressants, and proton pump inhibitors (PPIs). But nutrition is also a serious risk. Inadequate calcium intake and poor vitamin D status are significant factors in the ability to maintain bone health after bariatric surgery.

The ASMBS recommended intakes for calcium after bariatric surgery are as follows:

Adjustable Gastric Band (AGB): 1500mg calcium
Gastric Bypass (RNY): 1500 to 1800mg calcium as calcium citrate
Duodenal Switch (DS): 1800 to 2400mg calcium as calcium citrate

These recommendations are for calcium intake over and above dietary intake. While it may sound like a lot it is terribly important that your body gets the amount of calcium it needs. You need calcium to keep your heart beating and your brain functioning (as well as for other things). So when the body does not get enough coming in each day, it takes calcium from your bones to supply it to the heart and brain. People will often not know this until they actually break a bone.

Generally, the ASMBS recommends that AGB and RNY patients get 400 to 800 IU of vitamin D3 daily and that DS patients get 2000 IU of vitamin D3 daily. There is a lot of data indicating that vitamin D deficiency is very common both before and after surgery, and that many patients require higher doses of D3 based on their lab findings. If you have not had your vitamin D levels tested, it is a good idea to know what they are. Your doctor or dietitian can help you determine the amount of vitamin D you need to take based on this test.

To read more about the Mayo Clinic findings, you can click on the links below:

Mayo Clinic press release:
Article in Science Daily:

Sean C. Amore said...

Thanks for the clarification, Syl! I guess I didn't think about the fact that my daily calcium now kept the calcium in my bones for tomorrow (I'm an idiot, as you can clearly tell) and THANK YOU for the full research data and so on. I need to further up my calcium too, from the looks of it.

I owe you the year or two you've added before my first hip shatters!

Syl (previously known as Shib) said...

LMAO Trust me, I was horrified when I read that because I was taking maybe 800 mg of Calcium and my sister who's a doctor even yelled at me.

She also said we should get bone density tests done every few years.

Sean C. Amore said...

Admittedly I get about 1200 MG from supplements and 320 MG from my skim milk so I'm only "missing" about 300 a day BUT . . .

Good to know that even you were caught off guard, Syl. You always seem to be way up on your "stuff".

Hope all is well in Murrrrrlind!