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Ask Dr. K: Problems over the years

Posted On : September 09, 2010

There are numerous sources available on the internet for patients to search for information. The information that one can find ranges from scientific to anecdotal. Patients individually have asked me a number of questions and I will peridically address them in an “Ask Dr. K” newsletter. I would also like for my opatients to submit their questions by emailing it to me.

“Problems Over The Years”

Question:
“What are the main things we should be looking for “symptom wise” at 3, 5, 7, or 10, etc. years out.
I’d like to know how the duodenal switch effects teeth? On hydration as I think my body pulls water from my stool when I’m not drinking enough. Actually – it’s not “enough” it’s that my body passes it out my kidneys if I am not sipping constantly throughout the day. Is that normal? Omega Fatty Acids – are we screwed? What do those deficiencies look like?”

Answer:
I do not know of any particular study that looks at the health of the
teeth specifically, however, I would assume that if a patient is not
complaint with their Calcium, or even complaint, and they are deficient
in minerals such as Calcium, Vitamin D, Magnesium, and others, then
one can develop poor teeth. Hydration is a very important issue. Surgery or not, most of us tend to run around a little “dry”. Constipation may be a side effect of inadequate water intake.
For the Omega fatty acids, see the next newsletter dated 9/22.

Question:
I would love to know what types of problems are seen in post operative patients and what the distributions are by years post-op.

Answer:
In very broad terms, I can classify them in both time frame, and in term of causes of complication (mechanical vs. nutritional). See table 1.

Please note that this is by-no-means a complete list, only a brief, very brief, overview of some of the potential problems that may surface. This list is not meant to be all inclusive or complete.

Table 1
Post operative
Time Frame
Nutritional Mechanical
Days Dehydration Leaks, abscesses,
infection (urinary,
pulmonary) DVT, PE,
Wound dehiscence, Bowel
Obstruction
Weeks Dehydration, protein
calorie malnutrition-acute
Wound infections, DVT,
PE, Bowel Obstruction
Months Protein Calorie Malnutrition, mineral deficiency, Kidney stones Bowel obstruction,
Cholecystitis (if your
gallbladder not removed)
Years 1-3 Protein Calorie Malnutrition, mineral deficiency, Kidney stones Bowel obstruction,
Cholecystitis (if your
gallbladder not removed)
Years 3-5 Occasional mineral
deficiency, Kidney stones
Bowel obstruction, Skin
Rashes (if applicable)
Years over 5 Occasional mineral
deficiency, Kidney stones
Bowel obstruction, Skin
Rashes (if applicable)

Deep Vain Thrombosis (DVT) Where a blood clot is formed in the deep venous system of the lower legs and can travel and block the flow of the blood to the lungs. If large enough in it a common cause of death in post operative patients. DVT’s are not the same as varicose veins.

Pulmonary Embolism (PE) A clot or a tumor that is dislodged from one part of the venous circulatory system and blocks the flow of the blood to the lungs. The most common source for the PE is a DVT.

Wound Dehiscence Complete or partial breakdown of the suture line at the deep layers where the bowel may become unprotected. In some cases this needs re-operation on an urgent fashion.

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