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Subject:
From:
Linda Madsen <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 18 Dec 2007 22:26:26 -0600
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Dear Jaye:

At this point, you are dealing with incomplete information without having
the information on what kind of surgery your client had done & when. It's
important in terms of her dietary & nutritional supplement intake. What is
her food intake like?

As serious as it is for anyone to have an upper GI bleed, it is a serious
complication for someone who has had a procedure which limits the size of
the stomach. Hopefully, she is in communication with the team who performed
the bypass to let them know. Depending on when & where she had her procedure
done, some of the groups continue to follow patients long-term including
through pregnancy & beyond. There were some article citations dating from
1998-2005 but I can't access them here from the house computer.

Usually, gastric bypass patients do not have problems with gastric reflux.
Those who have GERD issues prior to surgery often find that the surgery (if
it is a roux-en-y) offers a permanent solution as the surgery separates the
section of the stomach that produces most of the acid from the upper GI
tract. It is recommended that gastric bypass patients stay away from
medications that would further decrease acid production or would increase GI
tract transit time as the surgery already speeds food moving through the
shortened GI tract. There is research available that there is a small
minority of patients who do have ongoing issues after the surgery...your
client may fall into that population.  Or, if she had a vertical gastric
banding (the older "stomach stapling") then she had a procedure that did not
reduce acid production, and in time may stretch back out in size or tear
out. She would be just as prone to gastric reflux as the rest of the world.

It's essential that the mother take her vitamin supplements, including B12 &
iron--not only to maintain her own health but her babies. There are also
reports of infants who have had failure to thrive, seizures, developmental
delays, & neonatal megaloblastic anemia due to their mother's inadequate
diet and nutrition.

I'm also concerned about what may have caused the UGI bleed. I'd be
interested in finding out what she was taking prior to the bleed--OTC,
prescription, herbal, as well as other gastric irritants such as alcohol or
smoking.

Linda Madsen, RN, BS
& Lap Gastric by-pass pt in 2000
Wylie, TX

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