For the protection of our patients, the staff will wear mask in the office.
For Telehealth follow-up and new consultations please contact us Here
1-818-812-7222
1-818-812-7222 Office Hours: Monday and Wednesay 8:00 AM to 5:00 PM

10 Congress St., Suite #405
Pasadena, CA 91105

Category: Vitamin D 25-OH

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.

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

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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.




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 website. This 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 D supplements

August 01, 2011 1:12 am

Vitamin D is a fat soluble vitamin.  It plays an important role in bone metabolism and structure. It has also been found to affect the immune regulation, control off- inflammatory reactions, and also be involved in a number of broad cellular functions throughout the body.  Until a few years ago, very little attention was given to vitamin D levels. More recently, we have realized that due to a number of factors, there is a tendency for vitamin D deficiency to be present in the U.S. adult population. This finding is even more pronounced and severe in overweight patients.
The recommended dose for vitamin D supplements is much larger today than it was a few years ago. For example, it is not too uncommon to recommend an average dose of a 50,000 (IU) international unit of vitamin D Dry Water Miscible (Water Soluble) by mouth on a daily basis after the duodenal switch operation. Since vitamin D is a fat soluble vitamin, it is important that the appropriate type be utilized. Dry formulation of vitamin D is needed to ensure adequate absorption. There are a number of manufacturers that produce these. When searching for one “Dry” D3-50 the patient would be looked for. Some larger supplement manufacturer’s carry these products. The links to these manufacturers is located here.
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