GI Tract Troubles

Photo by Annie Spratt on Unsplash

Gastric Sleeve Surgery (VSG) Can Cause Intestinal Problems

My SO had the gastric sleeve surgery in July and has been continuously losing weight – Down 40 lbs in about 4 months. But it has been a ride with many issues. She has been out of work since the surgery except for a handful of days that did not go well. Yesterday, my SO met with the surgeon’s nurse practitioner presenting with two weeks of “The Big D” – diarrhea – and the need to always be close to a bathroom. The nurse practitioner stated that GI Tract Troubles are not related to the Gastric Sleeve bariatric surgery and that my SO should go see her gastroenterologist.

Today she’s meeting with her gastroenterologist. So, I created the list of 10 items that should be discussed. Even though we are in a large metropolitan area, I still have my doubts on how familiar that the medical-community-at-large is with bariatric surgery / gastric sleeve surgery.

List of Questions:

1)  Leakage – The number one concern:  But a CECT should be able to determine leakage – but not in all cases.  The initial head fever was 100.5 deg, and then an hour or so after tylenol, the warm belly (101 deg F). Possibly Peritonitis?  Do a CECT scan to look for leakage / check white blood cell count.

2)  Usual causes should be excluded such as infection : bacterial / viral. Diagnosed with a stool sample.  Check white blood cell count.

3)  SIBO –  Small Bowel Bacterial Overgrowth: Postprandial bloating. Breath test or EGD with small bowel aspirate for quantitative culture. Rotating antibiotics.  Confirm with breath test – more prevalent in other Bariatric surgeries -but still a possibility treat with antibiotics and then have probiotics…

4) Dumping Syndrome: Feeling lightheaded, flushing, watery diarrhea. Start meals with protein, avoid simple sugars. Currently, drinking stops for 30 minutes after eating. Do we need to push to 30 minutes before and 30 after? Or 60/60?

5)  Gall Bladder issue / Gall Stones:  This is what the NP suggested.  Bile Salt Toxicity: Watery diarrhea. Cholestyramine.  (Gall bladder)  Gall Stones:  10%-42% of Bariatric patients without gallstones will develop them. 

6)  Check Zinc Levels – Zinc deficiency occurs in 36-51% post-bariatric – and you might have symptoms (change in food taste)

7) IBD / Colitis – is this a catchall diagnosis?  Ulcerative Colitis?

8)  Potential Liver issue (8 watery stools a day)  “However, the initial rapid weight loss following bariatric surgery can cause hepatic decompensation in patients with NASH.”  

What is the Doc’s stance on Probiotics:  “The usage of probiotics seems to reduce the gastrointestinal symptoms in the post-surgery. The usage of probiotics seems to reduce the gastrointestinal symptoms in the post-surgery”

Waiting Patiently…

… For this afternoon’s visit – and hopefully relief!

No Information Yet…

The visit was quick, the fever / belly temperature was indicative of an infection / bacterial / viral. The doctor said that it’s not a leak. They are going with a stool sample, and some prescription meds to see what is going on. She said the SIBO test isn’t worth it.

I would rather err on the side of caution and have some type of test / scan to prove that it’s not a leak rather than trust her instinct.

The doctor proved that she is not familiar with bariatric surgeries by stating that Gastric Sleeve Surgery patients aren’t associated with dumping syndrome. Although she has one (possibly her first bariatric patient before my SO) who has started experiencing dumping a year out of surgery. Again, I’m a little worried about her lack of experience.

Stool Sample
Stool Sample -Photo by Ruslan Bardash on Unsplash

Stool sample is scheduled for tomorrow – stay tuned for the stool sample results which, I hope, will be in by the end of the week.

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