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Subject:
From:
Linda Madsen <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Thu, 20 Dec 2007 19:00:29 -0600
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-----Original Message-----
Hello Robin,

Reglan is contraindicated in gastric bypass patients because it increases
gastric motility. The surgical procedure itself also increases food transit
time through the GI tract. 

Medication absorption & dosaging can also be affected as a result of the
surgery. It is important to keep in mind with all medications prescribed for
a patient who has had a procedure to alter the GI tract where a medication
is broken down & metabolized. Most people who have had a roux-en-y do not
use the upper 1/3 of their small intestine. This is the area that absorbs
many medications and nutrients such as B-12. It has been by-passed along
with the bottom 2/3 of their stomachs. Foods & medications are not digested
in that portion of the digestive tract any longer. 

B-12 must be ingested sublingually, IM, or IV. Folate, Iron & Zinc levels
are often found to be deficient in gastric by-pass patients. And, a large
percentage of patients do not continue with the vitamin supplement routine
past the first year postop despite the risks involved. Some time-released
medications are ineffective. Other medication doses must be increased to
achieve a therapeutic level in the blood. Drugs that are metabolized in the
liver do not need to be adjusted. Medications such as NSAIDS and aspirin,
gastric irritants are to be avoided as they can cause a GI bleed. Alcohol is
contraindicated because with the alteration in the GI system, the alcohol is
not broken down before it goes to the liver. It is more toxic to gastric
by-pass patients. They get drunker faster & the effects of the alcohol seem
to pass faster.

Dosages of herbal galactagogues would similarly need to be adjusted and the
side effects would also need to be reviewed prior to prescribing.

Postoperative issues for bariatric patients vary widely depending on the
procedure performed & length of time out from the procedure. A person who
has an adjustable laparoscopic band does not have to worry about the
absorption of nutrients as it is only a restrictive procedure. It only
changes the size of the stomach--it does not affect absorption of calories
eaten. Gastric by-pass is a restrictive & malapsorptive procedure. The new
gastric pouch is generally the size of the ball of one's thumb when new and
only gets slightly bigger with time depending on the stapling. It's
malapsorptive because a percentage of small bowel is bypassed. It moves food
through the body faster with less calories taken in from the food eaten. The
term gastric bypass does not mean two different people have had the same
procedure. It is essential if you have a client that has had a surgical
weight loss procedure to find out what type of surgery was done as it will
change the lactation management picture.

Linda Madsen, RN
Wylie, TX 

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