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What Next?

Not a happy time around the Breadbin.

The bariatric surgery Eva had three and a half years ago continues to provide us with surprises, none of them pleasant.

You may recall that everything seemed copacetic at first. She lost close to 200 lbs, and although she has regained some of that, she's a much healthier weight than she was when she was Eva-squared. Her diabetes, once heavily, heavily medicated with insulin, is now kept in check with pills alone. She--well, for a time she did have a lot more energy to burn.

But a year and a half afterwards -- almost two years ago, now -- Eva's mental health suddenly took a turn for the worse.

We still don't understand why malabsorption of her psychiatric medications took so long to manifest. But it did, and it precipitated a months-long medicine dance, trying to find something that kept her anxiety in check without her having to take five times the recommended dosage just for one times the recommended dose to actually absorb and do what it's supposed to. That was not fun to live beside. I can't even imagine what hell it was to live with.

I'm happy to say that problem was eventually solved. I'm not so happy to say that a further problem has suddenly appeared.

Eva has always been proud of her teeth. With good reason. She's always been cavity-free, her teeth nice and white and even. Certainly nothing like my chipped, cavity-ridden mess of a mouth. She's achieved this all on her own, without frequent dentist visits.

About a month ago, coming out of a bout with the flu, Eva suddenly had to deal with excruciating pain in her mouth. Smiling hurt. Yawning was torture. And chewing was agony.

Two broken teeth. SIX cavities, two of them in the broken teeth. A nasty infection. And even more worrisome, an eroding jaw.

What can that possibly have to do with bariatric surgery?

Malabsorption strikes again. This time, vitamin D.

Vitamin D has one major function in the human body, and that is to maintain adequate levels of calcium and phosphorus, both of which are integral to healthy bones and teeth. You're supposed to take a maximum of 2,000 units a day of vitamin D. Eva takes 6,000.

And even so, this is happening to her.

Rather than go for three root canals at $1000+ a pop, Eva elected to simply have two teeth yanked.  Which made everything fine...for all of two weeks.

Another infection. Two more cracked teeth. More cavities, too. Pain that is REALLY FUCKING UNFAIR.

For the first time, Eva told someone asking if she'd have the surgery all over again an emphatic NO.

I feel bad because I should never have taken what I heard at the initial seminar at face value. They utterly neglected to mention possible long-term side effects. They made it sound like as long as you didn't do something stupid like smoke a cigarette, drink soda or alcohol, or eat like a pig, your post-op life would be mostly sunshine and roses. Yes, malabsorption was covered: bariatric patients find themselves on a host of nutritional supplements for that reason. But nobody said boo about what turns out to be an extremely common after-effect: vitamin D deficiency shows up in SIXTY THREE percent of post-operation bariatric patients. What's worse, the pattern of eating you are expected to maintain -- grazing throughout the day, rather than three meals -- exacerbates the problem. So do chewable vitamin supplements (which Eva, thankfully, does not take).

The list of common deficiencies after gastric bypass includes but is not limited to:

  • protein
  • iron
  • calcium
  • vitamin D
  • vitamin B-12
  • vitamin A
  • vitamin K
  • zinc
  • magnesium
  • vitamin C
All of these are typically absorbed in the foot and a half of intestine that has been removed in bariatric surgery. What's really bothering me is that it seems like these deficiencies can stay hidden for years, only to pop up (surprise!) and prove extremely difficult to treat because of malabsorption.

I should have looked all this up. It may well have convinced her not to have the surgery, and to pursue weight loss by other means. Not that anything had worked in the past...that's why she was ACCEPTED for bariatric surgery in the first place!

So, so frustrating. And so, so expensive. Dental care is, for reasons of ancient professional ego, entirely separate from other forms of medical care in Ontario and indeed in North America. Dental benefits are sufficient for routine cleanings. Not for something like this. Hell, we don't even know exactly what this is going to turn out to have to be. Dentures? Implants? Jaw reconstruction? All of the above?

Daunting. Very daunting.

Wish us luck, folks. And if you meet Eva and she's not smiling at you, perhaps you can understand why.


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