Question:
Tell me why, again, that we shouldn't drink with our meals?
I'm finding it hard to stop drinking with my meals or directly afterwards. Why exactly is this a big no-no? My nutritionist didn't really have an answer to my question... Thanks! Open RNY 03/20/03 -87lbs — vittycat (posted on August 29, 2003)
August 29, 2003
It forces the food out of your pouch, making it possible to eat more (your
food becomes a soup of sorts) and consume more calories-
— ~~Stacie~~
August 29, 2003
I was also told that as the water forces the food thru the stoma that it
might stretch out the stoma, a big reason for weight regain.
— **willow**
August 29, 2003
Not only are you able to eat more at that meal, but you wash the food out
of your pouch, leaving it empty and you hungry again soon. People who
drink with their meals are heading for trouble in the maintenance phase,
and risk regaining weight. (You might not see an effect now, but you will
later, when it's harder to learn new habits.) If it's hard for you to
ignore a drink, then don't have anything to drink near you on the table.
This habit is well worth the effort to break, and not as hard as you think.
I'm not trying to be mean, just direct: knock it off unless you want to
risk failing at this long term.
— Vespa R.
August 29, 2003
If you drink with your meals it will force the food out of your pouch
quicker and cause you to be hungry, which causes you to eat more which WILL
cause you to gain weight. If you must drink something make sure it is at
least 30 min. after you eat. My doctor gives theis information to all his
patients. Hopes this helps. Good luck to you.
— Gene F.
August 29, 2003
Woah, dawgies. In reference to a post below in response to this question,
lately, the "stretched stoma" problem seems to be getting a lot
of mentioning in contexts that might be a tad overstated. An enlarged
stoma or a staple line disruption is a very real surgical failure (and by
that I do not necessarily mean the surgeon "blew it," btw) but
neither condition is as common as one might believe by reading the
Q&As. Most of us will never develop either condition, though we should
certainly be aware of the possibilities and fixes (or lack thereof, in the
case of the enlarged stoma).<P>Far, far more common is weight regain
from simply eating the wrong foods, not exercising enough, and grazing all
day (the same behavioural stuff we've always all struggled with). We have
to be careful *not* to blame those who develop enlarged stomas or staple
line disruptions for developing those conditions, because the causes of
those failures probably have little or flat-out *nothing* to do with
patient behaviors. On the other hand, we have to "own" the
little problem behaviors which we darned well know we have to grapple with
even after surgery in order to be successful in the long run -- behaviors
we can now fight much, much harder with the tool we have, but we still
gotta fight 'em, and not expect everything to be resolved surgically. One
way to fight 'em is to take some good advice, and not eat and drink at the
same time as that does, indeed, wash food out of the pouch more quickly,
enabling the eater to eat more sooner, in most cases. JMHO. (Flame away.)
— Suzy C.
August 29, 2003
I did not mean to flame or blame anyone. I know surgical failures occur
thru nobodies wrongdoing etc. However, it was brought up in a support group
meeting I attended when we were discussing stretchig pouches, the group
leader said, everybodies pouch stretches, this is normal and expected,
where thhr drs. have seen a bigger weight gain, poor loss is stretched
stomas and that they felt it was caused by drinking with meals, consistant
overeating and not chewing thoroughly enough.
— **willow**
August 29, 2003
Stretched stomas vs stretched stomachs (pouches)! Am I wrong here?...the
'stoma' is not the stomach (pouch)? Is not the stoma the opening into and
out of the stomach (pouch)? If you stretch the stomach you will be able to
eat more (and therefore gain weight) or worse, you COULD rupture your
staple line. I am stapled, double rowed, but not dissected. I would think
this would be fitting. If I develop a leak, it would leak back into my big
stomach and not my abdominal cavity. Am I right?
— Ginger M.
August 29, 2003
Our Baraitric program states that the "stomach is a VERY strong
muscle" an unless transected will work very hard to "pop"
those staples and "reconnect" itself. That is why they decided
several years ago to transect and triple staple and sew over the staples to
ensure the staple line does not fail-
— ~~Stacie~~
August 29, 2003
Ginger, the opening from the esophagus to the pouch is called the cardia -
this is not toughed during wls. A stoma is a surgically constructed opening
(usually made thru the abdomen for such things like colostomy). In our case
the surgeon contructs a new opening in the pouch, since the original, the
pylorus, is bypassed.
<p>
And you are right if you develop a SLD, the food would move into your lower
stomach and not your abdominal cavity.
<p>
As far as stretching the stoma: I hesitate to believe that drinking while
eating can affect the size of the stoma. If we were swallowing whole chunks
of meat and slugging back large amount of water, maybe. But really, if that
were to be possible, I would think that we wouldn't have to worry about the
stoma, cuz it would be coming back up! If we chew the food well, like we
are supposed to, and we happen to drink while eating, the resulting
"soup" would move out of the pouch too quickly. You either eat
more volume at one sitting, or you get hungrier faster later on. Either
way, you are eating more and could, as a result, gain weight back.
— Ali M
August 29, 2003
Darn typos!
<p>
That should be: the cardia is not TOUCHED during wls.
— Ali M
August 29, 2003
My understanding is that an enlarged stoma is the part of the pouch that
connects to the intestines and that, in some patients, it get so big it is
almost as big as the pouch, allowing patients to intake more food than is
desirable. The thing is, some folks have discovered they have one very
shortly after surgery -- meaning, they haven't had *time* to cause it
through overeating -- it is a "surgical failure" in the sense
that the body has compensated for the pouch by enlarging the stoma (or, as
has been pointed out also, some pouches will try to force the staples out,
as foreign objects, again, without the person being "bad" and
overeating). I've seen some people get really upset at these conditions
because others have pointed fingers and said, essentially, well, *you*
must've "outeaten" your surgery. We have to be careful not to
say that about conditions that arise in some people, where the body is
merely fighting what we've tried to do to it with the pouch. Where they
aren't to blame at all, is what I was trying to say. Often, patients
aren't told about these possible surgical failures, and are bitterly
disappointed when later on, they find out they fell into the minority that
developed them (and then, others suggest it's their own fault). Lots of
doctors don't tell their patients about these things -- I know I was told
about the possibility of a staple line disruption, but not about the
enlarged stoma thing. And I have no trouble believing these things happen
through no fault of the patient, but we *all* worry about
"stretching" SOMETHING (what would it be?!?) through overeating.
We know the pouch has gotta stretch a bit as it heals, and it's a stretch
material, anyway (supposed to be), or we'd starve in the long run with one
that's too tiny. I'm not sure the docs are all using precisely the same
terminology that I see evolving around here, either. It's definitely
confusing, but important to try to understand anyway, somehow!<P>For
what it's worth, my understanding is:<P>A Leak: Springs in the
staple line such that material can leak outta the pouch into the abdominal
cavity, and is life-threatening, and is typically tested for before a
patient is released from the hospital after WLS (though, not
always).<P>A Staple Line Disruption (or SLD): Can occur where the
pouch is stapled to separate it from the rest of the original stomach, no
matter how many rows of staples are used (and no matter whether the surgeon
also sews over the staples, and no matter whether he also says it's
"transsected" -- see my attempt at a definition of
"transsected", below). Sometimes the staples pop out, or force
themselves out, if the body rejects them as foreign objects. This isn't
common, but it does happen, and some folks get heartburn like symptoms;
some get no particular symptoms, but realize they can eat a heckuva lot
more than they could before; and some regain weight and find out about the
"SLD" following a barium test where, ooops, the docs see that the
whole stomach is gettin' food again, when it isn't supposed
to.<P>Transsected: Originally, I thought this meant that the pouch
was actually *cut away* from the original stomach by the surgeon, instead
of stapled off from it, and then sewn shut, so that the two were truly
separated (but, see definition of "Fistula" below). However,
I've noticed that a lot of surgeons will say, yes, you ARE transsected,
because I stapled your pouch off with eight rows of titanium steel staples,
and then I sewed over that. Well ... geez... to me, that's stapled and NOT
transsected, but if you're not explicit in asking your surgeon exactly what
he's done, some of them use the word "transsected" even though
your pouch was NOT cut away from the rest of your stomach.<P>Fistula:
A fistula develops when somebody who really WAS transsected (that is, had
their pouch cut away from the original stomach entirely, both sewn closed
separately from one another), develops a condition where, against all
sense, the body STILL tries to rejoin the two ... and a tunnel grows
between them as they rejoin one another. Darndest thing, isn't it?!? But
it does happen from what I've heard, even sometimes in the truly
"transsected."<P>Whew. There will probably be a dozen
folks who can tell me I got that all wrong, but that's what I've pieced
together from reading these boards for the past year, and darned if I EVER
heard about all those niceties from my surgeon prior to surgery. Scary ...
but still, relatively uncommon conditions. None of 'em the patient's
fault.<P>Sorry this was long-winded and off-topic, but I hope it
helps.
— Suzy C.
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