67 years Old, 10 years after Mini Gastric Bypass (MGB-OAGB) Surgery...

Doctor: Mr. Jatinder, tell us how long has it been to your surgery?

Patient: It has been almost 10 years, and 22 days to my surgery.  

Doctor:How much was your weight at the time of surgery?

Patient:My weight was 158 Kg.

Doctor:How much weight did you lose?

Patient:I lost almost 90 Kg. But now I gained 2-3 Kg.

Doctor:Today your weight is 82 Kg.

Patient:Yes! 82 Kg.

Doctor:You came down to 82 Kg from 158 Kg after Bariatric surgery.

Doctor:It is like one person is out from another.

Patient:Yes!

Doctor:Your weight was around 160 Kg.

Patient:Yes!

Doctor:How you are maintaining your weight?

Doctor:You said you gained 3-4 Kg weight during the lockdown.

Patient:Yes!

Patient:During the lockdown, I was drinking beer the whole day.

Patient:After stopping that, now my weight is stable.

Doctor:Ok.

Doctor:Surgery results depend on you.

Patient:If you drink less alcohol, then your weight will be under control.

Doctor:You were doing this for the last 10 years.

Patient:Yes!

Doctor:Weight fluctuates.

Patient:If I gain some weight then I lose it after some control.

Doctor:Ok.

Doctor:Now, we will talk about supplements. You have never taken multivitamins after surgery? or you had taken supplements for some time and then stopped?

Patient:I had taken multivitamins only for a year after surgery.

Doctor:Then, you have never taken any supplements.

Patient:No.

Doctor:You never had any deficiency.

Patient:No.

Doctor:Do you get your blood tests done regularly?

Patient:I get my blood tests done on every follow-up visit, last time I got my tests done from Chandigarh. You have all the records.

Doctor:Vitamin D deficiency is very common among everyone.

Patient:Ok.

Patient:I always had Vitamin B12 deficiency.

Doctor:We don't have to take all vitamins on daily basis. Sometimes patients get confused when we ask them to have all the supplements daily.

Doctor:In your case, you are taking Non-veg daily, and also your diet is healthy.

Doctor:A normal person needs 1500mg of calcium daily. There are a few of our patients who take 1.5-2 liter of milk products and don't need calcium supplements.

Doctor:Do you drink buttermilk daily?

Patient:Yes! In the morning.

Doctor: and curd?

Patient:Yes!

Doctor:One 250mg bowl of curd contains approximately 330mg of calcium.

So the curd is better than one tablet of calcium. And this is better quality calcium, which is easily digested and absorbed in our body.

Doctor:Ones who take 1-1.5 liter of milk or milk products daily can skip calcium tablets as they get enough calcium from their diet.

Patient:Ok.

Doctor:In some cases, taking calcium/supplements is not enough. Many people feel bone weakness after weight loss.

Doctor:Have you ever felt any weakness?

Patient:No.

Doctor:Are you active every day?

Patient:Yes!

Doctor:The main thing to understand is that if a person is bedridden for a long time,  he is having a bone weakness. If we give calcium supplements thrice a day, this doesn't make any difference because he is not doing any activity.

Doctor:Eating supplements will not make your bones strong, you need to do some exercise too.

Doctor:Like you are very active and doing exercise, walking daily.

Patient:Yes!

Doctor:Doing some physical activity improves your blood circulation. So, it is very vital for everyone to do some exercise for at least 20 minutes a day.

Doctor:Take a nutritional diet.

Doctor:Along with this, get your blood tests done regularly.

Doctor:As you have told us that you have Vitamin B12 deficiency, so we can give you a shot of Vitamin B12.

Patient:Ok.

Doctor:One shot of Vitamin B12 is good for 6 months.

Doctor:In some patients, we have to give Vitamin B12 shot once in 2-3 months.

Doctor:Getting Blood tests done is mandatory.

Doctor:The best option is to take 2 tablets of calcium daily.

Doctor:If you are taking a good amount of dairy products then you can skip supplements. Because diet plays a vital role in good health.

Doctor:How much alcohol you were drinking before surgery?

Patient:I used to drink 8 pegs of 60ml per day.

Doctor:After surgery how did you control it? or do you feel satisfied with less amount?

Patient:After surgery, I asked you when should I start drinking alcohol and you suggested, to wait for another 2-3 months.

Doctor:Ok.

Patient:I didn't take a sip after that.

Doctor:Ok.

Patient:When I came here for follow-up, you asked me about alcohol intake. Patient:Then I told you that I haven't started taking alcohol.

Doctor:Ok.

Patient:You advised me that I can take alcohol and I started after that.

Doctor:Ok.

Patient:Now, I take 3 pegs of 30ml daily.

Doctor:Do you feel satisfied with this amount?

Patient:Earlier I used to feel good after having 2 pegs only but now I take 3 pegs from last 5-6 years.

Doctor:Some patients drink a full bottle of alcohol daily even after surgery, and some say we drink more alcohol as compared to before surgery.

Doctor:It depends on patient to patient, everyone's response is different towards alcohol intake. The main thing is how a person controls over mind.

Doctor:Drink alcohol in an amount, so that you control it, not alcohol controls you.

Doctor:But if someone drinks more alcohol and can't handle it, then this will put a negative impact on the patient as well as on his family members.

Doctor:Sometimes patients think of reversal after losing a good amount of weight.

Doctor:Alcohol intake is not linked to this, the person who drinks alcohol regularly will drink after MGB reversal.

Alcohol intake will lead to weight regain and Sleep apnea recurrence.

Doctor:We have heard about people who die at a very young age while sleeping because of sleep apnea.

Doctor:Did you use to snore before surgery?

Patient:Yes!

Doctor:You had Severe sleep apnea?

Patient:Yes!

Patient:My surgery was postponed for one day, because of sleep apnea.

Doctor:Yes!

Doctor:What is the difference in your before and after surgery life?

Patient:There is a lot of difference now, I feel good after weight loss.

Patient:Now, I don't sleep while sitting, which was a major issue before surgery.

Doctor:Ok.

Patient:Yes!

Doctor:Daytime sleepiness was because of carbon dioxide retention.

Doctor:The main reason of snoring is tongue fall, which obstructs the exchange of gases (oxygen and carbon dioxide).

Doctor:Carbon dioxide levels will be on the higher side in a person who snores at night.

Doctor:That Carbon dioxide is like a poison, which leads to laziness and sleepiness in the daytime.

Doctor: Doctor:Now you are active the whole day.

Patient:Many people are suffering from sleep apnea, and are not aware of it.

Doctor:If a person snores at night and sleeps in the daytime is suffering from Sleep apnea.

Doctor:It is resolved when a person loses some weight around the neck.

Patient:Ok.

Doctor:Start taking multivitamins.

Patient:Ok.

Doctor:We will give you a Vitamin B12 shot today.

Patient:Ok.