Bougie Size- Infamous Pen Photo-Question ???
Interesting post.
I know for me at 7 months out that I've reached a point where my sleeve has settled.
I have a 32 oversewn.
Mostly my capacity depends on what I eat first.
If I eat meat first then there is no room for extras. Usually 2-3 oz.
If I eat veggies or potatoes first then those slide right through and I can keep eating although I eat a a much slower pace. And if I don't eat meat at all, then I find myself grazing.
Drinking anything at all with slider foods just makes the food move faster through the sleeve allowing more room for more food, more grazing.
Knowing this, at this point, helps me make better decisions.
I'm still trying to lose weight so I make it a point to eat the meat first.
Being able to eat different foods at this point makes the goal of 600-800 calories a day very challenging for me. Like in the old days. Although the sleeve does help.
However, even with exersize, I still have to keep the calories low or I don't lose.
donna
I know for me at 7 months out that I've reached a point where my sleeve has settled.
I have a 32 oversewn.
Mostly my capacity depends on what I eat first.
If I eat meat first then there is no room for extras. Usually 2-3 oz.
If I eat veggies or potatoes first then those slide right through and I can keep eating although I eat a a much slower pace. And if I don't eat meat at all, then I find myself grazing.
Drinking anything at all with slider foods just makes the food move faster through the sleeve allowing more room for more food, more grazing.
Knowing this, at this point, helps me make better decisions.
I'm still trying to lose weight so I make it a point to eat the meat first.
Being able to eat different foods at this point makes the goal of 600-800 calories a day very challenging for me. Like in the old days. Although the sleeve does help.
However, even with exersize, I still have to keep the calories low or I don't lose.
donna
HW/233 * SW/212 * CW/133 *GW/132 * 100 Pounds of FAT gone FOREVER!
Sometimes the questions are complicated and the answers are simple~Dr.Suess
Sometimes the questions are complicated and the answers are simple~Dr.Suess
(deactivated member)
on 3/31/12 10:54 pm
on 3/31/12 10:54 pm
Hi all.
Been lurcking for a loooong time. Having Sleeve April 19th.
Here's what my doc said to me about Bougie size - he uses the 36 because the 32 is just too flimsy. It makes it hard to get the stapler right up next to it because it bends around so much. No rigidity. This means while he is stapling up the stomach along the bougie, it can be easy for the stapler to actually go "off course" towards the top and not stay right snug up against the 32 bougie guide. This results in a bigger pouch.
Also - my nut showed us something truly horrid.
She said there is an observed phenomenon where a Sleever will have great restriction for months and months - but if they consistently "test" the sleeve and try to always eat until they get to the point of being stuffed, what will happen is that the valve to the esophagus will become "sloppy".
Meaning that instead of functioning like it should, it will start to get weak and stay open when you stuff yourself. This will allow food to kinda sit in the esophagus and that lower portion of the esophagus will actually dilate to become kinda like an extra mini-stomach above the valve.
The patient will feel "relief" when they stuff themselves because they'll think the sleeve has stretched out...in reality, you've got a sloppy valve and a dilated esophagus. This leads to weight gain, reflux and all sorts of other nastiness...the esophagus is not meant to hold stomach juices.
So - that is just what I was shown.
I've followed enough of Frisco's posts to know he preaches against testing the Sleeve...this is a good reason to follow that advice. Those valves are precious. Don't want to ruin them.
Been lurcking for a loooong time. Having Sleeve April 19th.
Here's what my doc said to me about Bougie size - he uses the 36 because the 32 is just too flimsy. It makes it hard to get the stapler right up next to it because it bends around so much. No rigidity. This means while he is stapling up the stomach along the bougie, it can be easy for the stapler to actually go "off course" towards the top and not stay right snug up against the 32 bougie guide. This results in a bigger pouch.
Also - my nut showed us something truly horrid.
She said there is an observed phenomenon where a Sleever will have great restriction for months and months - but if they consistently "test" the sleeve and try to always eat until they get to the point of being stuffed, what will happen is that the valve to the esophagus will become "sloppy".
Meaning that instead of functioning like it should, it will start to get weak and stay open when you stuff yourself. This will allow food to kinda sit in the esophagus and that lower portion of the esophagus will actually dilate to become kinda like an extra mini-stomach above the valve.
The patient will feel "relief" when they stuff themselves because they'll think the sleeve has stretched out...in reality, you've got a sloppy valve and a dilated esophagus. This leads to weight gain, reflux and all sorts of other nastiness...the esophagus is not meant to hold stomach juices.
So - that is just what I was shown.
I've followed enough of Frisco's posts to know he preaches against testing the Sleeve...this is a good reason to follow that advice. Those valves are precious. Don't want to ruin them.
Not going to join in the comments on what size is best or why.. but just wanted to throw my own anecdotal experience into the mix.. and I second what everyone regardless of their position says, do not count on the restriction to save you, do the right thing and let the restriction assist you. That said, I am very happy I have what I have.. not turning my back on that, it does make it easier.. I'd be lying if I said any different.
I am almost 1yr out, 36F over sewn.. staple line 3cm from the pylorus per the O.R. report.. I came out with restriction that would cause discomfort if I tried to eat a whole soft-boiled egg (during the mushies phase).. it was well over a month before I could eat a whole HB egg, and that took some time to do. Regarding small sleeves and reflux, just putting this out there- I had reflux going into this- was on 10mg generic Prilosec a day, still on the same dose post-op, and have not bothered to try to wean myself off it.. I may at some point, but I have been on that med for about 10yrs, so if it's a lifetime thing it doesn't bother me.
I still measure 2.25 oz meat and occasionally cannot eat the last bites as I'm comfortably full (not stuffed, not uncomfortable.. just satisfied belly feeling.. and I know I *could* wait 10-15 mins and finish those last bits w/o discomfort, but I don't.) I have never had the foamies, or pain.. but I did early out feel the pressure in my chest and quickly learned to slow down. I now can sit down with a weighed chicken leg, nibble my fill (15-20mins max, earlier out it would take me 30mins) and weigh the remainder and am generally spot on 2.25-2.5oz or less some days.. now shrimp, I can max out up close to 3oz, but that's just with them- so I take advantage of this, or sometimes have 2.25 & a tiny salad. This has not changed since about 4mo out (before that it was 1.5-1.75oz), will it in the future- possibly, who knows? I'm just going to continue on the path that has worked for me so far, measure & log, and adjust as needed.
I am almost 1yr out, 36F over sewn.. staple line 3cm from the pylorus per the O.R. report.. I came out with restriction that would cause discomfort if I tried to eat a whole soft-boiled egg (during the mushies phase).. it was well over a month before I could eat a whole HB egg, and that took some time to do. Regarding small sleeves and reflux, just putting this out there- I had reflux going into this- was on 10mg generic Prilosec a day, still on the same dose post-op, and have not bothered to try to wean myself off it.. I may at some point, but I have been on that med for about 10yrs, so if it's a lifetime thing it doesn't bother me.
I still measure 2.25 oz meat and occasionally cannot eat the last bites as I'm comfortably full (not stuffed, not uncomfortable.. just satisfied belly feeling.. and I know I *could* wait 10-15 mins and finish those last bits w/o discomfort, but I don't.) I have never had the foamies, or pain.. but I did early out feel the pressure in my chest and quickly learned to slow down. I now can sit down with a weighed chicken leg, nibble my fill (15-20mins max, earlier out it would take me 30mins) and weigh the remainder and am generally spot on 2.25-2.5oz or less some days.. now shrimp, I can max out up close to 3oz, but that's just with them- so I take advantage of this, or sometimes have 2.25 & a tiny salad. This has not changed since about 4mo out (before that it was 1.5-1.75oz), will it in the future- possibly, who knows? I'm just going to continue on the path that has worked for me so far, measure & log, and adjust as needed.
Thanks Elina! Between him & OH, it has been a great support system all around.. I was one who drifted off for a bit, other places, other things.. but the VSG board is a great support, and hey- I still get great tips coming here, like your graphing a set monthly weight.. I wouldn't have come across that idea on my own :)
First, don't you just love the word "bougie"? Sounds sort of sexy like " you are my darling little bougie". I may name my next pet "bougie". Its also a great Scrabble word for a 7 letter play when plural.
The pen photo demonstates how much this surgery is an art as well as a medical procedure and the surgeon must have the skill to make a complex judgement to get correct restriction that will last. It also tells us how much responsibility we must all take in learning to use our tool correctly. I have learned it is so important to learn those "full" eating cues regardless of the portion size dished out and that "full" means pleasantly sated and absence of hunger and does NOT mean stuffed like after a holiday meal. Thats what we all used to do for every meal.
I don't know the answer to the bougie size issue - only that my sureon uses the 32 for all and that his writings say that its because they found using larger ones were correlated with some weight regain at 4 or 5 years. I think I read that he has modified his technique to adjust where the staple line ends up at the top of the stomach near the esophogus as thats where extra tissue can eventually stretch.
What I know personally is that at 2.5 years I can eat considerably more than at even 10 months ago. I used to eat the protein first and often couldn't eat the few veggies i had served up with it. Now I can eat those veggies. So glad I got into the protein first habit as I am glad to end a meal with those veggies (not dessert) and I feel like I am eating healthier now that I can get more veggies in. And my sleeve helped me ditch the carb/sugar habit early out because I just couldn't have done much and now its so much easier to choose not to have these.
I mentioned to my surgeon that I could now eat more and he said I have a "mature" sleeve and it should stay at this capacity long term. Thats fine - can manage. But I sure don't want it to get bigger.
Interesting to watch my dh go through this as he is at 4 months and down over 80 lbs since surgery (121 total - he has lost an entire "Diane"). He now uses a timer to help slow his eating as he would often eat too fast and get sick. I am the family cook and have to be careful in serving portions as he is likely to eat whatever portion is served and will get sick.
Anyway, thanks frisco for starting this ruckus. Always interesting.
diane
The pen photo demonstates how much this surgery is an art as well as a medical procedure and the surgeon must have the skill to make a complex judgement to get correct restriction that will last. It also tells us how much responsibility we must all take in learning to use our tool correctly. I have learned it is so important to learn those "full" eating cues regardless of the portion size dished out and that "full" means pleasantly sated and absence of hunger and does NOT mean stuffed like after a holiday meal. Thats what we all used to do for every meal.
I don't know the answer to the bougie size issue - only that my sureon uses the 32 for all and that his writings say that its because they found using larger ones were correlated with some weight regain at 4 or 5 years. I think I read that he has modified his technique to adjust where the staple line ends up at the top of the stomach near the esophogus as thats where extra tissue can eventually stretch.
What I know personally is that at 2.5 years I can eat considerably more than at even 10 months ago. I used to eat the protein first and often couldn't eat the few veggies i had served up with it. Now I can eat those veggies. So glad I got into the protein first habit as I am glad to end a meal with those veggies (not dessert) and I feel like I am eating healthier now that I can get more veggies in. And my sleeve helped me ditch the carb/sugar habit early out because I just couldn't have done much and now its so much easier to choose not to have these.
I mentioned to my surgeon that I could now eat more and he said I have a "mature" sleeve and it should stay at this capacity long term. Thats fine - can manage. But I sure don't want it to get bigger.
Interesting to watch my dh go through this as he is at 4 months and down over 80 lbs since surgery (121 total - he has lost an entire "Diane"). He now uses a timer to help slow his eating as he would often eat too fast and get sick. I am the family cook and have to be careful in serving portions as he is likely to eat whatever portion is served and will get sick.
Anyway, thanks frisco for starting this ruckus. Always interesting.
diane
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Ok, so I have to admit there is some difference between restriction when someone has a larger sleeve. But it's down to so many things. Size of your original anatomy being one of the main indicators. As Dr. Alvarez showed in his infamous youtube video, you can use the same bougie on two different people and have one person with a much smaller sleeve and capacity than the other. I don't know how important it is overall. Most of the people I know have between a 32 Fr and 36 Fr bougie and they have all done fine and lost most or all of their excess weight. I don't know about larger sizes. I just know the studies I've read say that the eventual weight loss is almost exactly the same between a 32 F and 40 F bougie. One of the studies was 5 years out.
BUT I have to admit that it is probably harder to maintain that weight loss if there is more capacity. I just have no idea. None of us really know. I just know the people I've met with between a 32 and 36 Fr have all done basically the same. This is across many wls forums (about 4 of them) and people I've met at a local support group.
There really are so many what ifs. Who knows? But it's an interesting debate.
BUT I have to admit that it is probably harder to maintain that weight loss if there is more capacity. I just have no idea. None of us really know. I just know the people I've met with between a 32 and 36 Fr have all done basically the same. This is across many wls forums (about 4 of them) and people I've met at a local support group.
There really are so many what ifs. Who knows? But it's an interesting debate.
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