Category: <span>Medication</span>

My weight loss has corrected my hormone imbalance
Published Thu, 17th Jun 2021

My weight loss has corrected my hormone imbalance

I had an appointment with my endocrinologist today, and I was delighted to learn that my hormone levels are now back to normal!

I had been referred to the endocrinologist a couple of years ago by my oncologist when it was noted that my Testosterone levels were quite low, and I also had noticeable Gynecomastia (enlarged breasts in men).

Subsequent blood tests confirmed that my Testosterone levels were low and my Prolactin levels were high.

Hormone treatment

I had a scan done on my pituitary gland (a part of the brain which produces hormones) to check for problems, and thankfully that was fine.

I was put on medication to lower the Prolactin levels, and was then proscribed a Testosterone gel (Testogel) to apply to my skin every day. And both of these medications helped normalise my hormone levels.

However, following my bariatric surgery 10 months ago, the consultant was keen to find out if I still needed the medication – so we agreed that I would come off the meds about 3 months ago.

Anyway, so my bloods were tested last week, and the results show that both my Prolactin and Testosterone levels are now normal, which is being attributed to the 40 kg weight loss following my gastric bypass.

So naturally, I’m delighted that the hormone imbalance has corrected itself. It’s one fewer health concern to worry about, and it’s also one fewer consultant to visit!

Gynecomastia treatment

One of the known side effect in men of having high Prolactin levels is breast enlargement. However, having bigger breasts is also a side effect of being obese, so I’m not sure if my man-boobs (or ‘moobs’) are to do with my weight or the previous Prolactin levels (it may be both).

Either way, I was checking up on the treatment options for men with Gynecomastia. Basically the only effective treatment is to have liposuction, as most of the tissue in the breast is fat.

It’s classed as a cosmetic surgery, which is generally not covered by private health insurance – unless a medical case can be made for treating it.

Either way, I don’t think I’d qualify for the surgery at my current weight. I read somewhere that patients are meant to have a BMI under 25 before they are considered for Gynecomastia surgery – I’m guessing on the basis that losing weight will most likely reduce the man-boob size without surgery.

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Consultants Endocrinologist Gynecomastia Hormones Testosterone

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So I just got my COVID-19 vaccineimg 20210419 184439 2
Published Mon, 19th Apr 2021

So I just got my COVID-19 vaccine

I was finishing up work on Monday this week, and I got a call from the nurse from my GP’s surgery. They had a spare dose of the COVID-19 vaccine, and asked if I could come in straight away.

Apparently I was already on their list of high-risk patients because of my medical history (cancer / obesity), and was due to be invited to get the vaccine later in the week anyway. But because they had a spare dose, and I live very close to the GP surgery, they decided to call me in early.

I was delighted to get call, and accepted straight away, and 5 minutes later I was stood outside the surgery waiting to be called in.

It was the Pfizer-BioNTech COVID vaccine that I received. It was administered very quickly and painlessly. I was then asked to stay in the waiting room for 15 minutes (for observation) before heading home.

I also have a provisional appointment for my second dose in 4 week’s time, but that might change if the government decide to extend the time period between doses, to allow for more people to receive their first dose.

I feel very lucky to have received the vaccine early. At the moment, the Irish health authorities are only vaccinating people aged 65-69 and also those judged to be at very high risk because of their medical status. Other adults under 65 face a wait of weeks – if not months – until they can avail of their first shot.

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COVID-19 Vaccination Vaccines

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Why can’t gastric bypass patients take anti-inflammatories?figure 1691868 1920
Published Mon, 15th Mar 2021

Why can’t gastric bypass patients take anti-inflammatories?

I hurt my knee about 10 days ago while out walking.

Before I had my bariatric surgery, my first instinct would have been to treat the injury it with an anti-inflammatory painkiller such as ibuprofen.

However I was told by my bariatric team that after having a gastric bypass I’m not allowed to take any NSAIDs, at all, for the rest of my life!

What’s the deal with anti-inflammatory drugs after bariatric surgery?

NSAIDs (or non-steroidal anti-inflammatory drugs) are widely used to relive pain, reduce inflammation, and to bring down a high temperature. Some are prescription medicines and others are available over the counter.

Common types of NSAIDs are:

  • Ibuprofen
  • Aspirin
  • Naproxen
  • Diclofenac
  • Celecoxib
  • Mefanamic Acid
  • Etoricoxib
  • Indometacin

In bariatric patients these painkillers are meant to cause damage to the stomach. In particular they are said to cause stomach ulcers, and that’s the reason why they need to be avoided.

The reduced stomach size with all types of gastric surgery presents a major problem with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). Administration of NSAIDs in these patients carries an increased risk for serious damage to the stomach pouch, which may result in gastric ulcers.

https://www.practicalpainmanagement.com/treatments/pharmacological/non-opioids/ask-expert-nsaids-after-bariatric-surgery

So how can I treat aches and pains?

Well it seems that Paracetamol is safe to take – although it only helps manage the pain, rather than helping to reduce the inflammation.

I also checked with my doctor, and it seems that transdermal pain relief (that’s patches and gels) are a somewhat safer form of NSAIDs to take for bariatric patients. Apparently some of the drug can still get into the blood stream, but it’s much less that when taking pills orally, so the risk of stomach ulcers is (thankfully) much reduced!

Topical NSAIDs may have potential advantages when compared with oral NSAIDs. Several studies demonstrate that, perhaps because of low systemic concentrations, topical NSAIDs have a reduced risk of upper GI complications such as gastric and peptic ulcers

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2984542/

So for now, on my doctor’s advice, I’m able to use a pea-sized blob of Diclofenac based gel on my knee to help relieve the pain. And that seems to be doing the trick.

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Anti-Inflammatories Drugs NSAIDs Pain

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Getting my bloods doneSyringe 1574486 1920
Published Tue, 3rd Nov 2020

Getting my bloods done

I went to my GP yesterday to get my bloods done. This is part of the regular blood tests that I’ll have to get done, to check that the vitamin and mineral levels in blood are good following my bariatric surgery.

My bariatric team requires that I get bloods done:

  • Every 3 months for the first year
  • Every 6 months for the second year
  • Once a year thereafter

I could get my bloods done in the private hospital where I had my operation, but that’s really expensive. I’ve done it in the past, and it’s cost me around €70-100 for each visit. And the public hospital phlebotomy clinics are a bit hit and miss in terms of how long you have to wait.

It’s much easier for me to visit the nurse in my local GP surgery. It does cost me €35 to visit, but the benefit is that the surgery is only a 5 minute walk from my house, so it’s a quick visit.

I also needed to get an injection of Neo-Cytamen (vitamin B12) so I got that done as part of the same appointment. And for an added bonus the nurse also gave me a seasonal flu shot for free as well. So I have ended up with many holes in my arms!

Blood test protocol following bariatric surgery

  • FBC
  • U&E
  • LFTs (including Albumin)
  • Thyroid function tests (TSH, free T4)
  • Bone profile (calcium, phosphate, ALP)
  • Vitamin B12
  • Folate
  • Iron studies (ferritin, serum iron, TIBC)
  • Zinc
  • Lipid profile
  • Magnesium
  • 25-Hydroxyvitamin D

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Blood Tests Cost GP Surgery Post-Surgery

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Bariatric postoperative prescription
Published Tue, 18th Aug 2020

Bariatric postoperative prescription

The bariatric team sent me a prescription for all the medications I’ll need after surgery, so that I can have everything ready for when I come home.

I thought I’d share with you what’s on the prescription. But of course your medication needs may be very different:

Drug NameDoseFrequency
Clexane 40 mgTwice daily for 21 days
Lansoprazole30 mgOnce daily for 3 months
Ursofalk500 mgOnce daily
Solpadeine Max soluable2 tabsAs required over 2 weeks (one box)
Senna Liquid15 mlAs required over 2 weeks (one bottle)
Multivitamin1 tabTwice daily
Calcichew D3 Forte1 tabOnce daily
Ferrograd C1 tabOnce daily
Neo-Cytamen1000 mcgInject once every 3 months

I didn’t know what some of these medications were, so I looked them up:

  • Clexane is a drug to stop blood clots, and is provided in pre-filled syringes to self inject. I’ve used this before after surgery.
  • Lansoprazole helps reduce the amount of acid my stomach produces, and to guard against acid reflux. I’m already on Esomeprazole (Nexium) for acid reflux.
  • Ursofalk helps guard against cirrhosis of the liver and also helps dissolve gallstones.
  • Solpadeine Max is a brand name for a combination pain killer of paracetamol and codeine.
  • Senna Liquid helps with bowel movements.
  • Multivitamins are just a standard over-the-counter supplement.
  • Calcichew D3 Forte is a combination high-strength calcium and vitamin D3 supplement.
  • Ferrograd C is an iron supplement.
  • Neo-Cytamen is a vitamin B12 supplement.

I suppose the standard over-the-counter multivitamin combined with the additional iron and B12 supplements mean that I don’t need to take special bariatric multivitamins.

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Medication Prescription Supplements

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Vitamin and mineral supplements
Published Fri, 31st Jul 2020

Vitamin and mineral supplements

As I prepare for my bariatric surgery, one of the things I’ve had to get my head around are vitamins and minerals.

I’ve learnt that in both the pre-surgery and post-surgery diets it’s important to have vitamins and minerals supplements, because I’m not going to get enough of them from food in the restricted diets.

Getting the right supplements

So here’s the basics of what I’ll need to start taking every day:

  • 1 or 2 Multivitamins (with a minimum of 14g of Iron)
  • 3 doses of Calcium Citrate, combined with Vitamin D

Some dietitians recommend special bariatric multivitamins, as they contain a balance of vitamins specially formulated for bariatric patients. However it also seems you can get away with standard multivitamins, if you can also add in an additional dose of vitamin B12 and vitamin D.

I bought a whole load of standard multivitamins before I even realised there are special bariatric ones available. I also bought calcium carbonate supplements instead of calcium citrate.

Apparently the calcium citrate is better absorbed by bariatric patients, as it doesn’t need stomach acid to breakdown, and it also helps avoid getting gallstones. So I might need to get new calcium tablets.

Pre-surgery

Pre-surgery diets seem to vary, but all of them seem to recommend starting on the multivitamin and calcium citrate supplements when the diet starts.

For two weeks before surgery I’m going to be limiting myself to just 800 calories a day. This restrictive diet helps shrink the liver and make the surgery easier and safer. But the diet also means that I’ll not be getting all the vitamins I need from food, so I need help from the supplements.

Post-surgery

For the post-surgery diet, I learned that it’s important to have chewable or liquid supplements. For the first few weeks after surgery I’m going to be on a liquid-only, and then a pureed-food diet. And during that time I’m not going to be able to swallow any pills or capsules.

I’ll need all my medication and supplements to either be crushed into powder. And some medications that are not intended to be chewed can taste really bad, so I might need to mix them with something else to disguise the taste. Or, just get them in a chewable form.

Some multivitamins are available as gummies, but I’ve heard they can cause problems unless they are chewed really well before swallowing.

For the first 2 months I’ll need to take three calcium supplements and two multivitamins – all spaced out by at least two hours.

Time / MealSupplement
8.00am BreakfastCalcium Citrate (500-600 mg)
11.00am SnackMultivitamin with Iron
1.00pm LunchCalcium Citrate (500-600 mg)
4.00pm SnackCalcium Citrate (500-600 mg)
7.00pm DinnerMultivitamin with Iron
Example pre-surgery supplement plan

After 2 months

When I’m back on real food, a couple of months after surgery, I believe I’ll be able to tolerate tablets again, so I won’t need chewable supplements. But I will need to continue taking the calcium citrate and multivitamin supplements for the rest of my life.

I’ll also need to get regular blood tests to make sure I have enough vitamins and minerals in my blood, as a gastric bypass permanently limits the absorption of iron, vitamin B12, calcium and vitamin D.

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Calcium Citrate Post-Surgery Pre-Surgery Supplements Vitamins

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