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Category: Night blindness

Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

September 04, 2014 3:08 pm

Nycalopia or Night Blindness is a side effect of Vitamin A deficeincy. Vitamin A is a fat soluble vitamin that occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Beta carotene and other carotenoids, yellow and red carotenoid pigments, can be changed to vitamin A in the liver.

A number of functions for vitamin A have been found, including immune mechanisms, maintenance of healthy epithelial tissues,  facilitates the mobilization iron from stores to developing red blood cells, and most importantly, a function in the visual system. Vitamin A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle. Zinc works with Vitamin A by converting retinol to retinal and also protects from toxicity of Vitamin A. Vitamin A deficiency can worsen Iron Deficiency Anemia. It has been shown that treatment for Iron Deficiency Anemia responds better when Vitamin A and Iron are supplemented together.

Vitamin A deficiency may also represent a decreased visual acuity, more specifically, night blindness. Night Blindness was found in a patient who reported that they were unable to read a particular sign at night while driving, but was able to read it during the day. The body uses Vitamin A to make retinal, part of a molecule called rhodopsin. Rhodopsin is found in the rods of the eye.  The rods are the cells of the retina that allow you to see in low light conditions. Here is a video of a patient exhibiting the effect of night blindness.

Night blindness Video

If Vitamin A deficiency is left untreated at the stage of night blindness it can progress to Xerophthalmia.  Xerophthalmia is also caused by Vitamin A deficiency. The symptoms of Xerophthalmia is lack of tear production which are the lubrication of the eye. This leads to corneal and conjunctiva inflammation and thickening. The cornea can become cloudy and foamy spots (Bitot’s spots) leading to scarring and damage that effect the sight.

Over the last few decades, the incidence of vitamin A deficiency in the general population of the United States has significantly decreased. It is only when a patient shows signs and symptoms associated with malabsorption of fat soluble vitamins that he or she may be diagnosed with a vitamin A deficiency.
Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video
Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

When a patient is diagnosed with vitamin A deficiency, the treatment will require aggressive oral supplementation.  Duodenal Switch patients will only respond to “Dry” water miscible form of Vitamin A, which is pictured below/right. This “Dry” water miscible form is a powder which is designed to dissolve in water without the addition of bile for absorption. When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” water miscible form of vitamin A. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.

For cases in which vitamin A levels do not respond to “Dry” water miscible Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage of vitamin A is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize the vitamin A level, as well as resolving the symptom of night blindness.

Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

Vitamins And Minerals

March 29, 2014 5:26 pm

Vitamins -Minerals
Function
Source
Problems with deficiency 
B1 (Thiamine)
Carbohydrate conversion, breaks down fats and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, immune system
Pork, organ meats, whole grain and enriched cereals, brown rice, wheat germ, bran, brewer’s yeast, blackstrap molasses
Heart, age-related cognitive decline, Alzheimer’s, fatigue
B2 (Riboflavin)
Metabolism, carbohydrate conversion, breaks down fat and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, antioxidant
Brewer’s yeast, almonds, organ meats, whole grains, wheat germ, mushrooms, soy, dairy, eggs, green vegetables
Anemia, decreased free radical protection, cataracts, poor thyroid function, B6 deficiency, fatigue, elevated homocysteine
B3 (Niacin)
Energy, digestion, nervous system, skin, hair, eyes, liver, eliminates toxins, sex/stress hormones, improves circulation
Beets, brewer’s yeast, meat, poultry, organ meats, fish, seeds, and nuts
Cracking, scaling skin, digestive problems, confusion, anxiety, fatigue
B5 (Pantothenate)
RBC production, sex and stress-related hormones, immune function, healthy digestion, helps use other vitamins
Meat, vegetables, whole grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ, salmon
Stress tolerance, wound healing, skin problems, fatigue
B6 (Pyridoxine)
Enzyme protein metabolism, RBC production, reduces homocysteine, nerve and muscle cells, DNA and RNA, B12 absorption, immune function
Poultry, tuna, salmon, shrimp, beef liver, lentils, soybeans, seeds, nuts, avocados, bananas, carrots, brown rice, bran, wheat germ, whole grain flour
Depression, sleep and skin problems, elevated homocysteine, increased heart disease risk
B12 (Cobalamin)
Healthy nerve cells, DNA/RNA, RBC production, iron function
Fish, meat, poultry, eggs, milk and milk products
Anemia, fatigue, constipation, loss of appetite, weight, numbness and tingling in the hands ad feet, depression, dementia, poor memory, oral soreness
Biotin
Carbs, fat, and amino acid metabolism (the building blocks of protein)
Salmon, meats, vegetables, grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ
Depression, nervous system, premature graying, hair, skin
Folate
Mental health, infant DNA/RNA, adolescence and pregnancy, with B12 to regulate RBC production, iron function, reduce homocysteine
Supplementation, fortified grains, tomato juice, green vegetables, black-eyed peas, lentils, beans
Anemia, immune function, fatigue, insomnia, hair, high homocysteine, heart disease
Eyes, immune function, skin, essential cell growth and development
Milk, eggs, liver, fortified cereals, orange or green vegetables and fruits
Night blindness, immune function, zinc deficiency, fat malabsorption
Calcium and phosphorus levels, calcium absorption, bone mineralization
Sunlight, milk, egg yolk, liver, fish
Osteoporosis, calcium absorption, thyroid
Vitamin E
Antioxidant, regulates oxidation reactions, stabilizes cell membrane, immune function, protects against cardiovascular disease, cataracts, macular degeneration
Wheat germ, liver, eggs, nuts, seeds, cold pressed vegetable oils, dark leafy greens, sweet potatoes, avocado, asparagus
Skin, hair, rupturing of red blood cells, anemia, bruising, PMS< hot flashes, eczema, psoriasis, cataracts, wound healing, muscle weakness, sterility
Calcium
Bones, teeth, helps heart, nerves, muscles, body systems work properly, needs other nutrients to function
Dairy, wheat/soy flour, molasses, brewer’s yeast, Brazil nuts, broccoli, cabbage, dark leafy greens, hazelnuts, oysters, sardines, canned salmon
Osteoporosis, osteomalacia, osteoarthritis, muscle cramps, irritability, acute anxiety, colon cancer risk
Chromium
Assists insulin function, increased fertility, carbohydrate/fat metabolism, essential for fetal growth/development
Supplementation, brewer’s yeast, whole grains, seafood, green beans, broccoli, prunes, nuts, potatoes, meat
Metabolic syndrome, insulin resistance decreased fertility
Magnesium
300 biochemical reactions, muscle/nerve function, heart rhythm, immune system, strong bones, regulates calcium, copper, zinc, potassium, vitamin D
Green vegetables, beans & peas, nuts and seeds, whole unprocessed grain
Appetite, nausea, vomiting, fatigue, numbness, tingling, cramps, seizures, personality changes, heart rhythm, heart spasms
Selenium
Antioxidant, works with vitamin E, immune function, prostaglandin production
Brewer’s yeast, wheat germ, liver, butter, cold water fish, shellfish, garlic, whole grains, sunflower seeds, Brazil nuts
Destruction to heart/pancreas, sore muscles, fragility of red blood cells, immune system
Zinc
Supports enzymes, immune system, wound healing, taste/smell, DNA synthesis, normal growth & development during pregnancy, childhood adolescence
Oysters, red meat, poultry, beans, nuts, seafood, whole grains, fortified breakfast cereals, and dairy
Growth retardation, hair loss, diarrhea, impotence, eye & skin lesions, loss of appetite, taste, weight loss, wound healing, mental lethargy
COQ10
Powerful antioxidant, stops oxidation of LDL cholesterol, energy production, important to heart, liver, and kidneys
Oily fish, organ meats, and whole grains
Congestive heart failure, high blood pressure, angina, mitral valve prolapsed, fatigue, gingivitis, immune system stroke, cardiac arrhythmias
Carnitine
Energy, heart function, oxidize amino acids for energy, metabolize ketones
Red meat, dairy, fish, poultry, (fermented soybeans), wheat, asparagus, avocados, peanut butter
Elevated cholesterol, liver function, muscle weakness, reduced energy, impaired glucose control
N-Acetyl Cystein (NAC) & Glutathione
Glutathione production, lowers homocysteine, lipoprotein, heal lungs, inflammation, decrease muscle fatigue, liver detoxification, immune function
Meats, ricotta, cottage cheese, yogurt, wheat germ, granola, and oat flakes
Free radical overload, elevated homocysteine, cancer risk, cataracts, macular degeneration, immune function, toxin elimination
Alpha Lipoic Acid
Energy, blood flow to nerves, glutathione levels in brain, insulin sensitivity, effectiveness of vitamins C, E, antioxidants
Supplementation, spinach, broccoli, beef, brewer’s yeast, some organ meats
Diabetic neuropathy, reduced muscle mass, atherosclerosis, Alzheimer’s, failure to thrive, brain atrophy, high lactic acid

Vitamin D And A -Dry (Water soluble) Formulary

August 24, 2013 7:57 pm

Vitamin A and D are fat soluble vitamins. This means that in order for them to be absorbed by the GI track, them need to be absorbed by fat globules (chylomicrons). These are then taken up by the lymphatics of the GI track and taken to the blood stream. With the anatomical changes of the Duodenal Switch, the fat absorption capacity is significantly reduced. This results in excellent weight loss. It also results in much diminished absorption of the Fat soluble vitamins A, D, E and K. It is essential to use Dry Water Soluble forms of Vitamins A, D, E, and K.  Bio-Tech is a brand that is formulated in this manner.

Screen Shot 2015-04-05 at 2.41.02 PM

The Biotech D3-50 has 50,000IU of Vitamin D.

IMG_0889

We recommend specific dosages of dry (water soluble) Vitamin A and D. These are not available at most pharmacies. In fact when our recommendations are presented at most pharmacies they are incorrectly dispensed with the fat soluble variety with is worth less becasue it is not absorbed by the duodenal switch patients.  It is also important to not that this type of vitamin should not be taken with any dietary fat.  Fat can inhibit the absorption of this type of vitamin. When ordering online, please make sure that the “Dry” or “Water Soluble” formulary is ordered.




Injectable Vitamin A and Vitamin D

June 20, 2013 11:24 pm

Injectable Vitamin A and Vitamin D can improve vitamin status post weight loss surgery. One of the common side effect of all weight loss surgical procedures is nutritional and/or mineral deficiencies. Patients undergoing weight loss surgical procedures are always instructed to supplement their diet with multivitamin, calcium, iron, vitamin D and other supplements or minerals. If you do not take your supplements regularly you can become deficient. The symptoms associated with vitamin A deficiency is night blindness. Chronic vitamin D deficiency may result in low calcium, osteoporosis and other health-related issues.

Vitamin A and vitamin D, both fat-soluble vitamins, are absorbed by duodenal switch patients only if taken and a dry formulation. An alternative to oral supplement, would be injectable form of these two vitamins. Both of these vitamins can be formulated and purchased from compounding pharmacies that are equipped and experienced with the interpretation of injectable vitamins and minerals. Your primary care WILL need to contact the pharmacy of their choice for the recommendations and be willing to make the injections available to you.

We will gladly be able to provide injectable Vitamin A and Vitamin D for patients whose data laboratory studies are available to us and see us in the office.

We will not be able to provide prescriptions for injectable vitamins to be sent to your primary care or other physicians to provide the injections.

Vitamin D supplement has been discussed previously in my Blog .

The common dosing for the vitamin D is 600,000 IU, deep IM every 6 months till the levels are normalized. The patient then can take the oral supplements only.

Vitamin A supplements was also discussed in my Blog.

Injectable Vitamin D

The common dosing for the vitamin D is 600,000 IU, deep IM every 6 months till the levels are normalized. The patient then can take the oral supplements only.

Vitamin A supplements was also discussed in my Blog.

The common dosing for injectable vitamin A is 50,000 IU, deep IM every 6 months till the blood levels are corrected, and the patient symptoms are resolved.

Central Drugs Compounding Pharmacy 562-691-6754 , Located in La Habra, California can provide both injectable Vitamin A and D with a prescription and sent to your physician.

Just as a reminder, we have no financial interest in any of the vendors that are recommended on our website. Also, note that this is not in any form or fashion a substitute for an evaluation by your primary care physician or your surgeon. This is for information only, and is not to be taken as a recommendation for any particular patients’ condition.

Yearly lab and medication requests

October 17, 2011 5:28 pm

 

As a practice matures and evolves, decisions are made and changes are instituted to assure that the delivery of quality care is not compromised. Most of our decisions are driven by factors (medical, regulatory, and legal) that are out of our control. There are two significant changes that we have had to make to our laboratory ordering process.


First, we now have preferred laboratories that have partnered with us. The laboratory results are expected to be sent to us electronically, which should cut down on the time between the blood draw and when the results are available to us. The information on the preferred labs is located at:  https://www.dssurgery.com/lab.  Needless to say, there are no financial incentives for us. You should also check with one of the labs, as well as with your insurance company, to make sure that they are a contracted facility and that the order is covered under your policy. It is your responsibility to make sure that your insurance company will pay for the labs ordered. We are in no way responsible for the verification of benefits for the laboratory services that we order.

Second, we have had to change the way we order our yearly lab work. As most of you are aware, it is critical that weight loss surgical patients have continuous yearly follow-up care and monitoring. It is critical that the patients continue to receive yearly follow-up care, not only by doing their scheduled laboratory studies, but also by a yearly follow up in office exam. We provide a comprehensive follow-up plan to the patients who have had the the Duodenal Switch or Revision from other failed weight loss surgical procedures. This includes ordering the laboratory studies, review and interpretation of the results, as well as office visits as frequently as required or deemed necessary. 
Due to medical, legal, and insurance issues, we can not order yearly laboratory studies without having seen the patient in our office prior to writing the order. Some patients may choose to have their labs ordered by their primary care physicians, in which case we suggest they review the information on our websiteThis is to assure that we are not ordering tests on patients who will not follow up with us, and the PCP’s that  have ordered the labs will be able to review the results and make recommendations.  We apologize for this change, however, our hands are figuratively tied.

Over the years, patients have also requested that medication be prescribed solely based on lab results, even if the patient has not been seen by our office in years.   We will not prescribe medication to any patient who has not been recently seen by our practice. An exception would be for patients or conditions whose treatment we have a firsthand knowledge of, that are not new findings based on a patient’s long-term condition.  There are cases when a patient calls our office 8 years after surgery asking for Flagyl to treat gas, which we will not prescribe. 

Vitamin A

May 17, 2011 7:20 pm

Vitamin A occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Disorder yellow and red carotenoid pigments can be changed to vitamin A in the liver.

A number of functions for vitamin A have been found, including defense mechanisms, maintenance of healthy epithelial tissues, and most importantly, a function in the visual system.  A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle.  A deficiency may also represent a decreased visual acuity, and more specifically, night blindness. This was found in a patient who complained that they were unable to read a particular sign at night while driving, but was able to read it during the day

Over the last few decades, the incidence of vitamin A deficiency in the United States has significantly decreased. It is only when the patient shows signs and symptoms associated with the malabsorption of fat soluble vitamins that he or she may be diagnosed with a deficiency.

Vitamin A Deficiency Treatment

IMG_5427
Injectable Vitamin A

When a patient is diagnosed with a deficiency, the treatment will require aggressive oral supplementation. For cases in which vitamin A levels do not respond to “Dry” Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize their level, as well as resolving the symptom of night blindness.

When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” or water miscible form. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.