Partial Gastrectomy – Six Years Later

The most oft-read post on this site is Partial Gastrectomy – One Year Later. When I was preparing for surgery in 2008, and an uncertain future after that surgery, I searched the web for information, both factual and anecdotal, about what would lie ahead.  Experts on medical sites laid out the facts…but it was the personal experience shared by those who lived each day “post-gastrectomy”, that I really valued.  Each of us has a unique experience but there are similarities that only we will share and for that reason, this blog continues….

 

It’s now 2015 and it’s six and a half years since I had my partial gastrectomy with vagotomy and pyloroplasty (for the gory details, please visit the earlier post).  I was re-reading that post earlier today and it was interesting to see how little had changed.  I still weigh 115 pounds and I wear size 0/1 jeans that I have to buy in juniors department.  Now…I’m 52 years old so I don’t want to sound like I’m complaining because I never would have imagined that I would look the way that I do at this age.  I “look” very fit and in many respects, I am well…but I work very hard at it.

 

I still eat several small meals throughout the day, no more than a cup of food at any given time, and liquids and solids are kept separate, for the most part.  To ensure that I get the nutrition that I need I take supplement meals in addition to my regular meals, a high quality multi-vitamin, minerals, antioxidants and other nutrients that I might not be able to eat or absorb in sufficient quantity given the limited capacity of my stomach.

 

Sugar, simple carbs, and high-glycemic foods are “out” since I began having seizures 4 months after my surgery.  The cause of the seizures was not immediately identified but, over the years, I have recognized that the blood sugar swings that result from the pyloroplasty (which results in dumping syndrome) is, for me, a seizure trigger.  Dehydration, lack of sleep, and even the slightest amount of stress can lower the seizure threshold, but the biggest trigger is sugar.  I’ve been on seizure medications since 2009 and when I had been seizure-free for several years in 2012, my neurologist and I began a process to wean me off of the medication.  Originally the seizures had been tonic-clonic, aka Grand Mal, and it took heavy doses of medication to keep them under control.  As I was weaned off the meds and reached a very low dose, the seizures returned, but this time as complex partial seizures.  I would become dizzy, draw inward, and eventually black out for a few seconds but without losing consciousness.  Typically this would occur over the course of 15 or 20 minutes; on one occasion, it took just a few minutes.  Of course, I reported the return of seizures to my neurologist and I am now at a medication level that keeps me stabilized…and I am very careful about my diet.

 

At the upper portion of my stomach, where the esophagus was reattached and a stricture formed…the stricture continues to be an ongoing concern necessitating the daily use of a proton pump inhibitor (omeprazole) to prevent discomfort, GERD, and the inability to swallow.  It’s been several years since I have needed to have the stricture dilated but I take 20 mg omeprazole twice a day to maintain a happy situation there.  I have tried to wean off of PPI’s and use ranitidine (75 mg), a histamine H2 blocker, but after 2 or 3 days of ranitidine in the morning and omeprazole in the evening, the stricture starts to “complain” and I am back to my normal routine.  I’ve discussed this with my gastroenterologist and surgeon and the response from both has been that I may just have to live with the PPI’s.  Hmmm, well, ok….but, this has been a concern because…

 

…I am a 52-year-old woman and I went through an early menopause when I went through chemo.  These are all factors that can contribute to osteoporosis and last week I was diagnosed with osteoporosis following my second DEXA scan.  I’ve scheduled my first annual Reclast IV infusion and I’m going to have another chat with my gastroenterologist to see if there are any new options for managing my stricture.

 

I continue to visit my oncologist annually and my recent visit went well.  My blood work, including B12 levels, all came back normal.  B12 can become a concern five years after the surgery so it was good to know that I’m doing well in that regard.  My ferritin level had dropped but this was likely due to surgeries that I had in September 2014…


…but that is a story that I will save for my next post.

Post-Gastrectomy Syndrome and Iron Deficiency Anemia

For several months, I’ve been particularly fatigued, needing at least one nap before leaving for work in the afternoon.  I sleep well at night and should feel well-rested and yet I’m fatigued and recognize the familiar symptoms of iron deficiency anemia.  The results of my blood work from my recent annual visit with my oncologist were good…with the exception of my iron levels which remain at the low end of the normal range.  I supplement with 27 mg ferrous gluconate, taken with vitamin C on an empty stomach but, as described in this article on Post-Gastrectomy Syndrome, my ability to absorb iron has been compromised by my surgery.

Wanting to have more energy, less fatigue, and prevent complications due to low iron levels, I’ve contacted my doctor about having a blood transfusion.  We’ve discussed this course of action in the past but this will be my first transfusion…if my insurance company approves.  I’ll keep you posted….  🙂

Note:  It has now been 4 1/2 years since my surgery.