Almost 6 Years Out: Adventures in Post-Op RnY Blood Chemistry

I had my RnY bypass in 2011, and ever since then, several things have been weird. 

Over the past five almost six years, on occasion my RBC and Hematocrit would be a bit high. Next blood tests, back to normal. However, over the last year (so the last four blood tests, my RBC and Hematocrit has been high, a few points outside of normal range. Couple this up with my hereditary Factor Five Leiden Mutation, I'm always vigilant about minimizing my risks for clots, DVT and stroke. 

Three months ago I discontinued my iron supplement to see if that impacted anything. My iron levels all remained normal; however, my RBC and Hematocrit are still on the high side.
Additionally, my blood pressure (though treated with medication) hasn't really gone down all that much (not that it was super high, while medicated either, but I really want to get my bp down to 120/70, and before/after my bypass, it has remained around 138/80). My elevated bp is treated with an ACE inhibitor.

Another weirdness is, I've been watching my uric acid, for signs of gout. My normal is around 5; however, without changing ANYTHING, my uric acid on my last test jumped to a 6.3--I think a 7 is actually entering the realm of gout.

Up until about a week ago, in addition to a prenatal gummy multi vitamin I take (it doesn't contain iron, but does contain b12) I was blasting myself with KAL brand sublingual b12 spray, which contains 2500 mcg of b12 with each spritz. I was in the habit of blasting myself with two spritzes each day for a total intake of 5000 mcg daily.

For the last week I've been researching this, and managed to find some useful information on the topic, and I really feel that the nutritionists who counsel us as part of the surgical pre-screening process etc, should really be more well-read on the supplementation, especially since they all seem to tout the same top four items: iron, calcium, b12, and d3. Yet, I do not recall if I got any specific information about WHICH specific formulations are best for post-oppers, as well as dosing (the only thing I recall being specific was 2000 mg of calcium citrate daily).

Anyway, the Mayo Clinic's website provided some good information on the risks of b12, so, here are the caveats for b12:

1. If you have a blood clotting disorder--see a specialist to find out how much b12 is too much for your purposes. EXCESSIVE b12 coupled up with a blood clotting disorder could be dangerous.
2. If you are hypertensive and being treated with an ACE inhibitor, speak to whomever is treating you for your hypertension to find out how much b12 is too much for your purposes.
3. If you have elevated uric acid or actually have been diagnosed with GOUT, talk to whomever is treating you for your gout to find out how much b12 is too much--as too much b12 can exacerbate gout flares.
4. Not to sound alarmist, but excessive b12 can carry a cancer risk. How much is too much? I'm still looking into that! But this is just one of many articles regarding elevated b12 as markers for elevated (certain) cancer risks in legitimate medical journals:
   https://www.ncbi.nlm.nih.gov/pubmed/14636871

Pain Chronicles: New Pain Doc

On October 13th, I had my initial consultation with the person who is my new pain doc.

Granted, she's not what I would deem "local" to me, it SHOULD only take a half hour to get to her office, yanno, provided I put her CORRECT address in my Waze. And driving into CT now is an exercise in "rage management," my god. The traffic. So between the traffic and my gaffe at the wrong address, I managed to show up a half hour late to the office--and MERCIFULLY, they still managed to see me.

Granted, due to the time constraint, the appointment was thorough and stayed on point, and no room for chit chat. I articulated quickly what my chronic issues are, and what my acute issues are. I provided diagnostic imaging reports for everything, blood work, you name it. I come prepared. No real room for too many questions on my part, but she was able to come to a very quick theory of what is causing the acute issues. She was able to do in about a half hour what the previous (SHITTY) pain doc couldn't manage to do in a year's worth of visits, and come to the conclusion that the hip problems are the result of some injury or instability to my knees (which isn't a wild goose chase, as I have taken two very bad tumbles in the last ten years).

A follow up appointment was scheduled for 10/24. We discussed some sort of injections, possible cortisone for the elbow (not my first choice!), trigger point injections of lidocaine in my neck and shoulders, and if the insurance would approve it, hyaluronic acid in my knees.

The appointment on 10/24 went as planned. The shot in the elbow was guided by ultrasound imaging, and I was watching on the screen as she did the injection. Which, I've heard horror stories about cortisone injections, and while this was not "pleasant," it wasn't the worst possible thing I've endured.

Next up were the trigger point injections. She started between my shoulders and worked her way up my neck, working quickly and without any real reaction from me, with the last shot to be pretty much behind my right ear. Once the last shot was done, my stomach churned a bit, and I started to feel disconnected like I was entering some sort of vacuum. Before I knew it, I was on my way to passing out.

Fortunately, I recovered quick, and I also had a therapeutic massage scheduled with her therapist, immediately after the appointment. And immediately after that, I went across the hall for xrays of my hip (which I cc'd my chiropractor).  

She sent me on my way with prescriptions for an MRI of my right knee (which I had done 10/22), and I need to go in for an arthrogram this coming Friday, which I am not looking forward to, as they will be injecting contrast material directly into the capsule of the hip, and doing an MRI.

I see my chiropractor tomorrow night, so I should get all my copies of the reports thus far, as well as get more info from him on his knowledge of what to anticipate during an arthrogram.  Initially I was just going to take a half day off from the office--but I reconsidered, and am taking the whole day. I'm just going to go home after, and nap until physical therapy at 4, and pretty much take it easy the rest of the time.

I follow up with the pain doc for another appointment on 11/11, where I suppose I'll have more shots and another massage. 

At this rate, I hope to be feeling considerably better by the time Christmas is here. I hope.