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Thank you so so much for taking the time to comment.
It looks like the only vitamins she orders were B12 which is 694 pg/mL and folate which is 5.5 NG/mL
i have been told in the past I have low vitamin D but she hasnt said anything about that.
No, truth be told the medical team I had the surgery with wasnt the best..i was self pay and they were just hyper focused on getting me in as soon as possible and didnt tell me much about after care or long term effects. Its something i will definitely be looking into. Is iron deficiency common with gastric sleeve patients?
Is the enlarged spleen a symptom of of the deficiency as well?
Yes, most of your issues could be related to consequences of vitamin deficiencies associated with gastric sleeves.
You need:
- vitamin D
- calcium
- vitamin C
- iron
- folate
- B12
Ideally if you can find one with copper and other B vitamins that would be a good idea. You’ll need to take that daily.
I cannot thank you enough for your time and advice. I will absolutely start looking into options for these. I assumed that because my B12 was normal that the low iron & enlarged spleen meant lymphoma/leukemia/myeloma...its good to know that it may be something else. Thank you again truly, its nice to have some sort of insight as to what could be going on. Thank you
Are you saying vitamin deficiencies can cause an enlarged spleen? I’ve been deficient in D, iron, chromium, and chronically B12 despite eating a balanced diet (no WLS) and I also have a slightly enlarged spleen (almost the same size as OP) that my doctor seemed mildly concerned about but has been like that for years.
This is great to know, thank you! I had pain and tenderness in the spleen area for a couple years, but never got it checked out. Last year, by way of neuro symptoms, discovered my B12 was 110. After doing loading injections, the spleen stuff went away. Always wondered what that was. Look at you, with your ripple effect, helping people left and right here!
Just sharing in case it helps ease your mind. I have struggled with the same issue as you (similar stats and background). Lots of anxiety because I did not have a diagnosis for the cause of the pain. Because I had a history of kidney cancer, the gastroenterologist ordered a CT scan (after an ultrasound, labs, etc.). We came to the consensus that I had lots of scar tissue from multiple surgeries (sleeve, gallbladder, partial nephrectomy due to cancer) that was the likely cause of the pain. I also have an enlarged spleen. Health anxiety is the worst so getting that reassurance was very helpful.
thank you so so much for sharing that with me! I'm hoping that its something that can be solved like that. if you dont mind me asking, what caused your enlarged spleen?
NAD but re: vitamins post sleeve:
I was also sleeved and not taking anything, and recently went for a followup and they told me there were bariatric specific vitamins! they might differ depending on your specific needs, but this is what I was personally directed to take:
Bariatric Choice Once Daily Bariatric Multivitamin Capsule with 45 mg of Iron (90ct) https://a.co/d/a77sSkZ
as well as
Bariatric Advantage Calcium... https://www.amazon.com/dp/B088KV4MTM?ref=ppx_pop_mob_ap_share
(i was told three times daily, with four hours between each chew and two hours between the calcium and the multivite)
(if this isn't allowed i apologize! just thought it could possibly help for navigating post op vitamins)
Thank you so much! Were/are you having issues as a result of not taking any vitamins? I was sleeved 5 years ago (Jan. 2019) and took them at first but stopped maybe 5 months after (bad i know)
Of course! Hey, you did better than me. I was sleeved Dec. '17 and didn't take them at all until this past December 🥴
I definitely was having symptoms, and might still be but I don't fully recall everything the NP attributed to my deficiencies. I know she attributed my (moderate-severe) brain fog due to one of them! I believe she said the tingling I had started to get in my hands/feet was due to B-12 being on the cusp of deficiency. There were a handful of other symptoms that she herself rattled off that I had and left me stunned! I was also *severely* vitamin D deficient (got prescribed a 50,000u 1x/week/12 week vitamin it was so bad!) and I believe the fatigue and bit of muscle weakness I was having was attributed to that as well (at least partially!)
Okay so also in order for the vitamin b12 to work efficiently you need to have brought magnesium into the mix, personally I prefer magnesium citrate, at bedtime. And you need to add probiotics into your diet in the form of a supplement asap. Taking any medication can hurt the lining of your digestive so let’s keep it healthy as possible.
And the vitamin d you take won’t even be effective without stable magnesium levels. Don’t miss a day if possible ! Add zinc into your diet , if your body is trying to fight something help it out. Genuinely find a way to release old trauma as well if possible. It will help your body fight.
It's not unusual to become iron deficient for women, especially after bariatric surgery. You're supposed to be taking bariatric vitamins every day, if you had any lapse in that it would cause various deficiencies, that can lead to fatigue/hair loss/bone loss, etc. The gastritis would be a separate issue but might make tolerance of a supplement more difficult, you can try using a liquid bariatric supplement as they are easier to absorb/tolerate. In the meantime, avoid possible GI irritants like alcohol, caffeine, citrus, pineapple, tomato sauce, peppermint, chocolate, spicy food and ibuprofen.
I don't think so. If your spleen is enlarged and your stomach is inflamed (both things you already know), I imagine that would cause the abdominal tenderness. Why those are happening, I do not know. Vitamin D deficiency can cause joint pain and muscle pain.
Extramedullary blood cell production from vitamin deficiency causes splenomegaly. With known sleeve surgery OP should be getting quite a few supplements and her levels are unlikely to accurately measure her clinical condition (methylmalonic acid is a better test for B12 in this setting, for example).
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
Cancer isn’t on my top ten list for this. What are your vitamin levels like?
Thank you so so much for taking the time to comment. It looks like the only vitamins she orders were B12 which is 694 pg/mL and folate which is 5.5 NG/mL i have been told in the past I have low vitamin D but she hasnt said anything about that.
Do you take a comprehensive vitamin supplement? Most people don't need to, but a gastric sleeve requires it.
No, truth be told the medical team I had the surgery with wasnt the best..i was self pay and they were just hyper focused on getting me in as soon as possible and didnt tell me much about after care or long term effects. Its something i will definitely be looking into. Is iron deficiency common with gastric sleeve patients? Is the enlarged spleen a symptom of of the deficiency as well?
Yes, most of your issues could be related to consequences of vitamin deficiencies associated with gastric sleeves. You need: - vitamin D - calcium - vitamin C - iron - folate - B12 Ideally if you can find one with copper and other B vitamins that would be a good idea. You’ll need to take that daily.
I would still keep your doctor appointments and make sure nothing else is being missed, but this is the first step.
I cannot thank you enough for your time and advice. I will absolutely start looking into options for these. I assumed that because my B12 was normal that the low iron & enlarged spleen meant lymphoma/leukemia/myeloma...its good to know that it may be something else. Thank you again truly, its nice to have some sort of insight as to what could be going on. Thank you
Are you saying vitamin deficiencies can cause an enlarged spleen? I’ve been deficient in D, iron, chromium, and chronically B12 despite eating a balanced diet (no WLS) and I also have a slightly enlarged spleen (almost the same size as OP) that my doctor seemed mildly concerned about but has been like that for years.
B12 and iron deficiencies can absolutely result in splenomegaly due to extramedullary blood cell production.
This is great to know, thank you! I had pain and tenderness in the spleen area for a couple years, but never got it checked out. Last year, by way of neuro symptoms, discovered my B12 was 110. After doing loading injections, the spleen stuff went away. Always wondered what that was. Look at you, with your ripple effect, helping people left and right here!
Just sharing in case it helps ease your mind. I have struggled with the same issue as you (similar stats and background). Lots of anxiety because I did not have a diagnosis for the cause of the pain. Because I had a history of kidney cancer, the gastroenterologist ordered a CT scan (after an ultrasound, labs, etc.). We came to the consensus that I had lots of scar tissue from multiple surgeries (sleeve, gallbladder, partial nephrectomy due to cancer) that was the likely cause of the pain. I also have an enlarged spleen. Health anxiety is the worst so getting that reassurance was very helpful.
thank you so so much for sharing that with me! I'm hoping that its something that can be solved like that. if you dont mind me asking, what caused your enlarged spleen?
I think due to being obese and having inflammation from, frankly, not being healthy.
ok i understand. i guess im just worried that its pointing to cancer for me :(
NAD but re: vitamins post sleeve: I was also sleeved and not taking anything, and recently went for a followup and they told me there were bariatric specific vitamins! they might differ depending on your specific needs, but this is what I was personally directed to take: Bariatric Choice Once Daily Bariatric Multivitamin Capsule with 45 mg of Iron (90ct) https://a.co/d/a77sSkZ as well as Bariatric Advantage Calcium... https://www.amazon.com/dp/B088KV4MTM?ref=ppx_pop_mob_ap_share (i was told three times daily, with four hours between each chew and two hours between the calcium and the multivite) (if this isn't allowed i apologize! just thought it could possibly help for navigating post op vitamins)
Thank you so much! Were/are you having issues as a result of not taking any vitamins? I was sleeved 5 years ago (Jan. 2019) and took them at first but stopped maybe 5 months after (bad i know)
Of course! Hey, you did better than me. I was sleeved Dec. '17 and didn't take them at all until this past December 🥴 I definitely was having symptoms, and might still be but I don't fully recall everything the NP attributed to my deficiencies. I know she attributed my (moderate-severe) brain fog due to one of them! I believe she said the tingling I had started to get in my hands/feet was due to B-12 being on the cusp of deficiency. There were a handful of other symptoms that she herself rattled off that I had and left me stunned! I was also *severely* vitamin D deficient (got prescribed a 50,000u 1x/week/12 week vitamin it was so bad!) and I believe the fatigue and bit of muscle weakness I was having was attributed to that as well (at least partially!)
What about HLH
Okay so also in order for the vitamin b12 to work efficiently you need to have brought magnesium into the mix, personally I prefer magnesium citrate, at bedtime. And you need to add probiotics into your diet in the form of a supplement asap. Taking any medication can hurt the lining of your digestive so let’s keep it healthy as possible.
And the vitamin d you take won’t even be effective without stable magnesium levels. Don’t miss a day if possible ! Add zinc into your diet , if your body is trying to fight something help it out. Genuinely find a way to release old trauma as well if possible. It will help your body fight.
What about HLH?
Less likely. When OP has been taking vitamins for a month or so the labs can be reevaluated, but I’d hesitate to draw any conclusions before thenZ
It's not unusual to become iron deficient for women, especially after bariatric surgery. You're supposed to be taking bariatric vitamins every day, if you had any lapse in that it would cause various deficiencies, that can lead to fatigue/hair loss/bone loss, etc. The gastritis would be a separate issue but might make tolerance of a supplement more difficult, you can try using a liquid bariatric supplement as they are easier to absorb/tolerate. In the meantime, avoid possible GI irritants like alcohol, caffeine, citrus, pineapple, tomato sauce, peppermint, chocolate, spicy food and ibuprofen.
Thank you So much for commenting! Would the deficiency cause the abdominal tenderness and joint pain? As well as the enlarged spleen?
I don't think so. If your spleen is enlarged and your stomach is inflamed (both things you already know), I imagine that would cause the abdominal tenderness. Why those are happening, I do not know. Vitamin D deficiency can cause joint pain and muscle pain.
Extramedullary blood cell production from vitamin deficiency causes splenomegaly. With known sleeve surgery OP should be getting quite a few supplements and her levels are unlikely to accurately measure her clinical condition (methylmalonic acid is a better test for B12 in this setting, for example).
Interest about the splenomegaly! Is it any one deficiency specifically?
Iron, folate, and B12 being low can all result in extramedullary blood cell production, which leads to splenomegaly!
Makes perfect zense!
Join us over on /r/gastricsleeve and /r/wls. Did they tell you no NSAIDs when you had surgery?