Recommendations

Overall, Mrs. Smith is doing well two years after Roux-en-Y gastric bypass. She has gained 4.2 kg since her nadir weight. A small weight gain is common after the nadir weight is achieved. However, it is important for the patient to avoid gaining any additional weight in the next year. The patient should also be reminded to adhere to the diet which was given to her by the bariatric team and to continue exercising on a regular basis for a minimum of 150 minutes per week.

In review of her laboratory values, she has iron-deficiency anemia despite the consistent use of once-daily Vitron-C. She did note that her menses are very heavy every month, and she has recently been fatigued.  The patient should undergo a one-time iron infusion to increase her iron stores and continue once-daily Vitron-C. In 3 months, her CBC and ferritin should be rechecked to ensure that she does not need additional therapy. All other laboratory values are within normal limits. She should continue taking twice-daily multivitamins, twice-daily calcium citrate with vitamin D, and once-monthly vitamin B12 injections.


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The patient should have her next follow up in one year with laboratory testing and consideration of a dietitian visit. 

Julia Jurgensen APRN, CNP, practices at the Mayo Clinic department of Endocrinology, specializing in diabetes management and obesity.

References

  1. Levinson R, Silverman J, Catella J, Rybak I, Jolin H, Isom K. Pharmacotherapy Prevention and Management of Nutritional Deficiencies Post Roux-en-Y Gastric Bypass. Obesity Surgery. 2013;23:992-100.
  2. Presutti J, Gorman S, Swain J. Primary Care Perspective on Bariatric Surgery. Mayo Clinic Proceedings. 2004; 79(9)1158-1166.