-----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 *********************************************** Archives: http://community.lsoft.com/archives/LACTNET.html To reach list owners: [log in to unmask] Mail all list management commands to: [log in to unmask] COMMANDS: 1. To temporarily stop your subscription write in the body of an email: set lactnet nomail 2. To start it again: set lactnet mail 3. To unsubscribe: unsubscribe lactnet 4. To get a comprehensive list of rules and directions: get lactnet welcome