No labs at three months out?

[sandyv63]

I think the office is incorrect. I remember having this conversation with Dr. K and we agreed I'd have labs done every three months for the first year. Of course I was pretty stoned at the time so I might be remembering a hallucination...

Anyway, I think I will just have my PCP write up the blood work order. But I have no idea what to test for at three months. I know it isn't as comprehensive as the 6 month draw. Can someone please tell me what I should have checked at 3 months out? My PCP isn't going to know.

[Deleted]

I recall--I hope correctly--that he is reluctant to chase after problems that will self-correct with time.

I have to assume that his approach is based on chasing after too many deficiencies that self-corrected with time. But I was nervous anyway. (I really don't recall IF I had a three-month draw...but I could go look if you start getting antsy.)

[RedSkittles]

It depends if you have any specific concerns. Too many post ops have ended up with potassium problems that I would at least want a metabolic panel.

I wonder if Dina has any opinions on it, since she works in bariatrics and sees post ops really often.

[majormom]

If you had some low levels or approaching low levels as a pre-op I would hope he would have you recheck at least those levels in addition to the regular panels.

[Seeking Healthy]

I am a Dr. K patient as well. I had my first set of draws at 3 months then I waited for 6 mos from that draw to do my next. I went through my PCP. However, I was deficient in some of my labs going into my revision. The 3 month draw was not something Dr. K ordered but rather something I instigated.

[sandyv63]

I looked at my pre-op levels and I was mid-range in everything except iron. I was low-normal. I am taking all my vites now but it took at least 6 weeks to get there so I am concerned I may be trending down in something that I could correct now. Last April I had a parathyroid tumor removed which of course screwed with my calcium, PTH and particularly my D. I managed to get my D back up to 55 just prior to getting the DS but I just don't know if I am at least maintaining. Maybe I should just get my iron, calcium, PTH and D levels checked. Oh, and my electrolytes of course. What else can tank in 12 weeks?

[majormom]

Perhaps your your B12, vitamin A, ferritin in addition to what you listed. Iron serum, hematocrit and hemoglobin should be part of the panel.

[sandyv63]

I'll include this as well. Thanks!

[RedSkittles]

Maybe thiamin (b1) too. That can drop quickly and cause a lot of neurological problems.

[Deleted]

This is one area where I disagree with Dr. Stewart in Denton, TX. He doesn't want to see any labs until at least 6 months postop. I think that there are a lot of problems that can develop between surgery and 6 months out.

Severe vitamin deficiencies may not be much of a concern in the first few months. Electrolyte levels, glucose, cell counts, and iron levels are all equally important and need to be trended over time.

Hypokalemia (low potassium) is a significant concern immediately postop and is the great mimicker in DSers. Its symptoms can even be mistaken for bowel obstruction since hypokalemia can cause paralysis of the bowel. That's something I'd rather prevent than try to figure out after the fact in an intensive care unit or in a post-anesthesia care unit following an unnecessary surgery.

The frequency of labs is up to the individual and their physician ultimately. It also may be limited by copays if one has high deductibles. I did labs EVERY month my first year, but I also firmly believe "anal-retentive" deserves a hyphen. After my first year, I slacked off to every 3 months x2, then every 6 months. I'll probably personally stay on an every-six-month schedule unless I start noticing trends developing that require more frequent monitoring.

When it comes to labs, an ounce of prevention is truly worth a pound of cure. I highly recommend following labs closely and trending those labs for developing patterns. Don't wait until 6 months postop or until problems develop. Take a very proactive approach and your body will thank you for it.

[meredith123]

I had a huge set of labs done at 3 months. My surgeon ordered them, then they gave me a prescripion for my 6 month labs and looks like they are testing a lot then too. They found at my 3 month labs that my copper was getting way to high and reduced me to one every other day instead of 1 every day. My Vit D level was also getting a little too high, but she said to keep taking that one and they may reduce if it gets higher at the 6 month labs. Everything else came back great, no other adjustments yet.
I'll go look in my car and see if I can find my preseciption and I'll let you know what they ordered.

[meredith123]

Here's my list that I have for my 6 month labs:

Comprehensive Metabolic Panel
Lipid Profile (Chol, Trig, HDL,LDL,Calc)
CBC with differential
B12
Bili-direct
Ferritin
Folic Acid
Iron/TIBC
Magnesium
Protime INR
PTT (APIT)
Selenium
Thiamine (B1)
Uric Acid
Vitamin A
Vitamin D, 25OH
Vitamin E
Parathyroid Hormone level
Copper
Zinc

I'm think the 3 month labs were pretty similar, but I didn't keep a copy of that prescription.
Hope this helps.