Question:
I am concerned that I have stretched my pouch or outlet--how easy is it to do that?

I am 8 months post RNY. I was only 100 pounds overweight at the time of my surgery and have lost 81 of it with 19 more to go but here is my issue....I am losing very, very slowly now which my doc says is normal especially the closer to your goal weight that you become. I can accept that without a problem but I am concerned because in the first 3-4 months post-op it seems like I could only eat like half of what I eat now before I am satisfied. I am very concerned that because the volume of food I eat now is so much more than it was in the beginning that I have somehow stretched the outlet or the pouch itself. It also seems like the feeling of satiety is not as pronounced as it used to be and that I can eat much faster and can even guzzle water and swallow 3-4 pills at a time which is a big change from the first few months post-op. I am looking so good but am so afraid that once the honeymoon period is over and the functionality of malabsorption is drastically reduced that eating the volume I eat now will cause me to regain the weight. I know that I tend to be a worry wart and my nut says that most people do not understand just how hard it is to actually stretch out a pouch or stoma but I am still so concerned that I am not normal. People are always talking on this site about eating up to 1 cup or 8 oz of food at a time. I have never really weighed or measured anything. I eyeball my portions and just try to make smart choices and eat until I fell satisfied but not stuffed to the gills. I think that I can eat way more than a cup of food. I can eat a whole large dinner plate of greens and a chicken breast or a 7 oz filet and a few bited of potato and a dinner salad and be happy, satisfied and comfortable. This morning I ate a cup and a half of bran flakes with a cup and a half of 1/2% milk. Just as an example, I have eaten two tacos or two pieces of pizza or most of a 6" subway sandwich in the past as well. Just using these as volume examples---I do not eat those things as a rule! Any feedback would be so much appreciated. I need to know that I am ok and have not ruined my precious pouch.    — ChelleBelle (posted on August 19, 2008)

August 18, 2008
I'm so glad that you sent this. I have been feeling the same way. I'm 8 months post op and down 81 lbs too! In the last few weeks I've noticed that I'm not losing very much at all and that I can eat alittle more. I'm having days where I feel hungry all day and am having to FIGHT hunger. I wish I had an answer for you, but wanted to let you know that I am feeling the same way and you're not alone. I was thinking of doing that 5 day pouch test to see if that helps me or not. Have you read about that or tried it yet? I don't know what else to do. Hang in there. Maybe someone will respond today and help us both.
   — MandyR

August 18, 2008
I am right with you. I am 3 months post op and I am afraid too. Recently I have been able to eat more and it freaks me out too. going forward I am going to limit my portion sizes to avoid this from happening. It scares me because I still have about 70 pounds to lose to get to my goal weight. I ate a sandwich yesterday with some cottage cheese and I am freaked out.
   — tayee24

August 18, 2008
It is hard to stretch the pouch. If you want to test what it holds, the first thing in the morning, not one hour after you are up but the first thing, fix 1/2 cup of scrambled eggs, and 1/4 cup. Use a baking b\cup so you are sure of the mesurement. Then eat the 1/2 cup, qand if you are not full eat the 1/4 cup. when you feel ful or can not eat any more that is your real limit as the eggs will not slide through the pouch. Make sure you do not drink before or during this test and of course at least 1/2 hour afterward. If you do not finish the 1/2 cup measure the eggs left over and subtract the oz from the 4 oz in the 1/2 cup for your capacaty. Every doctor does the pouch differently. I asked for mine to be as small as possible so I have a limit of 3-1/2 oz. Also have you tried the 5 day Pouch Test to give you that feeling you had when you first had surgery? Hee is how it works and what to do. 5-day Pouch Test I beleive was developed by a WLS patient by the name Kate Bailey and used to determine if her pouch was working and go back to that tight newbie feeling we all had right after surgery. As a bonus to this plan, it helps one get back to the basics of the weight loss surgery diet and it triggers weight loss. Also, it is not difficult to follow and if you are in a stage of carb-cycling it will break this pattern. Sounds pretty good, right? Here we go! Days One & Two: Liquid Protein The first two days are all liquids. You can have as many low-carb protein shakes as you like to satisfy hunger or cravings. In addition drink at least six 8-ounce glasses of water each day. The purpose of all liquids is to break any snacking, grazing or processed carbohydrate habits. In addition the liquids will work to cleanse your system and prepare you for the following three days. Try to reduce your caffeine intake as well, but do not stop caffeine cold turkey or you will feel sick and frustrated potentially losing the desire to continue with the pouch test. If you notice symptoms of carbohydrate withdrawal you can eat a small piece of melon or an orange. You can also try a dose of Emergen-C which should reduce headache, dizziness or cramping from carbohydrate withdrawal. The next three days you get to eat as much as you want as often as you want! Ahhh, but there's a catch: it has to be solid protein and you only get 15 minutes each time you sit down to eat. Day 3: Soft Protein Protein Recommendations: canned fish (tuna or salmon) mixed with lemon and seasoned with salt and pepper, eggs cooked as desired seasoned with salt pepper and/or salsa, fresh soft fish (tilapia, sole, orange roughy), baked or grilled, and lightly seasoned. This starts your program with "soft" protein. Measure your portion (1 cup volume or 4-6 ounces weight) and eat only until you feel full, not overfull. Remember, no water for 30 minutes before or after you meal, and no fluids with your meal. We are going back to the beginning and fluids will prevent you from feeling the pouch. If you need to add a bit of Miracle Whip or mayonnaise to the canned fish I understand, but keep it to a minimum so the meat is not too moist. One reason we lose the sense of tightness in our pouch is that we eat "slider foods" - foods that are too moist and do not stay in the pouch very long, they slide right through the stomach. Day 4: Firm Protein Protein Recommendations: ground meat (beef, turkey, lamb) cooked dry and lightly seasoned, shellfish, scallops, lobster steamed and seasoned only with lemon, salmon or halibut steaks, grilled and lightly seasoned. By now you should be experiencing that familiar tightness that will reassure you that your pouch is working. Remember to drink plenty of water between meals. Take some time to meditate and rediscover the wonder of your pouch. Often we do not like that uncomfortable tightness of the pouch, which is why we gradually move toward slider foods that don't make us uncomfortable. It is always my preference to eat moist protein so I do not get uncomfortable, but this allows me to consume more than I should. Rediscovering the pouch with this 5-day plan reminds us of how the tool really works. Hope by now you are rediscovering your tool and enjoying the hope and excitement because your pouch still works. A word about constipation: A shift to high protein diet often results in constipation. To relieve this you may try adding a fibrous fruit snack to your morning and a fibrous vegetable snack in the afternoon. Fruit suggestions are apples, berries, apricots, cantaloupe or oranges. For vegetables try leafy greens, zucchini, cucumbers, spinach, summer squash or string beans. Day 5: Solid Protein Protein Recommendations: white meat poultry cooked dry and lightly seasoned, beef steak (if tolerated) grilled or broiled. Remember to chew chew chew. Measure your portion (4-6 ounces) and eat only until you feel your pouch tighten. Remember, only 15 minutes per meal, so you will have to work fast to chew your food completely. By now you should be out of any carb cycle you were in and perhaps you have lost a pound or two. You will have new confidence in your pouch and your ability to work the tool for your health and emotional well being.
   — William (Bill) wmil

August 19, 2008
HI I'm a pre-op and cant talk about volume yet. But My Nurtitionist did cover this. She said the sweeling goes away from surgery and you are able to increase your volume. I think measuring your portions are important. How can you know your protein and caloric intake if you dont. Sparkpeople has a area you can track you foods. Goodluck
   — urbrat2

August 19, 2008
It's very hard to stretch your pouch...however, there are ways to gain weight without stretching your pouch. Grazing is one way...Grazing on unhealthy, processed, sugary, white flour, carbs is another way. It's not so much about how much you can eat in one sitting as much as what you are eating in one sitting or all day long. One extra large slice of pizza, heavy on the cheese is about 800 calories!!!!! It has about 40 grams of fat (most of which is saturated...bad!) and 73 bad carbs...But it also has a good 44 grams of protein...Add the greasy meats like sausage or pepperoni and you can bring that calorie count to over 1000. No joke! Take a lean 8 ounce roasted breast of chicken without skin and you've got the same 44 grams of protein, no carbs, only 6 grams of fat, for 240 calories...Most of us cannot even eat an entire 8 oz chicken breast. I eat half of that and add some asparagus sauteed in a spritz of olive oil and sprinkle with some parm cheese...add a side salad with garden veggies and a light dressing and you've got a GREAT lean meal no where near the horrible stats of a large slice of pizza...You want that pizza flavor...put a little sauce on the chicken breast and melt some mozz cheese on top...It adds a little calories and fat, but nothing like that pizza. After the weight loss stops, it's all about the quality and leanness of your food and the choices you make. Make your own thin crust individual pizzas on low carb wraps. They are awesome...(Hint: toast the wrap til crispy in the oven first ...then add toppings or else it will be too soggy) I can eat a 6 inch sub at Subway too...But I only do that once in a while because I only eat grains and breads three or four times a week in moderation. I like my daily carb totals to be equal to or less than my protein intake...(It doesn't always work out that way...but mostly it does) That's about 100 g of each...25-40g fats total and 25-40 g fiber...We absorb calories with no trouble...So even if we don't absorb fat and nutrients as well...our bodies find a way to absorb the calories instead...to compensate...That is how someone can be malnourished (vit deficient) and gain weight too! I suggest you start a food journal and figure out the stats and calories and begin measuring out servings and try to eat 4-5 ounces of protein and 2-3 ounces of veggies and occasionally a 1/4 cup (1 oz) rice or potatoes. See how well you feel. It might surprise you how much you actually DON'T need to feel good and satisfied. Whatever you do, DON'T begin eating more than you do now. make better morning choices too...You are eating carbs for breakfast...for 330 calories and only 5 g of protein (not including the milk) and 66 g of carbs! (you can subtract the nice 14 g of fiber from 66 gs of carbs) That makes 52 carbs...(Your breakfast is half my daily max for carbs) Add that milk and you have quite a loaded breakfast that could be sooooo much leaner...1/2 C cereal with a boiled egg or scrambled egg beaters and a small fruit (apple slices with peanut butter) or plain yogurt with NSA preserves...Choices make the HUGEST difference in a cup of food...Think about it...I can eat too! But I keep my calories low and my exercise steady and I maintain my weight now 4.5+ years...You can do this and even have that huge slice of pizza once in a while...I do (That's how I found out how many cals a giant slice of Costco pizza has!) By journaling your food intake you willlearn more about yourself and where you can cut back on wasted calories or eat leaner etc. Here's a great free site...Even if you just want to see how may calories are in a certain food or signature restaurant meal (Talk about shocking!!!! Now I KNOW why I was so big!) I hope that helps...The more you learn the more confidence you have in your pouch and yourself. It's work...but it's easier than you think...Now you just have to talk to your head and make certain it takes orders from your pouch...Good luck...
   — .Anita R.

August 19, 2008
I can only respond to this by my own experience. I am 8 months out too. I can eat a little more than in the first few months. But total at one meal, does not exceed more than around a cup. That is eyeballing too. I have never fixed my food on a regular sized dinner plate since surgery. I use a 8" plate for myself. I have had cereal, but not often, and that was around a half cup, just moistened with milk. I find that a boiled egg fills me up for bfst. Make the right choices. Take care of your pouch! Good luck to ya!
   — lesleigh07

August 19, 2008
I saw my surgeon today; I am about 6 1/2 months post-op. He told me for solid foods, I should eat a max of 4 ounces at a time. 800 calories per day. NO breads, crackers, pasta, rice, potatoes. Avoid carbs and sugars like the plague. Eat mostly chicken, fish, tuna, eggs, beans. Afte that, vegetables, and to rarely eat fruit. I believe what he advised it what is best and will lead to the best long term weight loss. I personally had an experience 2 weeks ago where I found my appetite had greatly increased; I felt hungry constantly and could not figure out why this suddenly was happening......... with the help of members here, I realized it was because I had made a few bad food choices and was eating too many carbs and too much salt. I had eaten a frozen dinner with mashed potatoes and gravy; loaded with salt and carbs!!!!!!! Also, crackers. I swear; as soon as I cut out the carbs and salt and went back to mainly proteins like tuna and low-fat cheeses and beans with some vegetables, I immediately found my hunger was back to a normal level. I really think you should consider stopping eating things like subway sandwiches or potatoes and get back to the rules as I my Doctor said (above). Try to reduce the quantity you eat at one time, and be careful not to drink before, during or too soon after meals. Faithfully take your vitamins and proteins. You may wish to see a Nutritionist or make an appointment with your surgeon. Best wishes to you,
   — Gina S.

August 21, 2008
First...congratulations on your 81 pound weight loss!! Fantastic !! Second, I think it might help to lay off the carbs. You said it in your last three words...."my precious pouch"....now imagine "two pieces of pizza" (all doughed up in there) or "most of a 6" subway sandwich" (all doughed up in there) Yes, it is precious. So remember how you treated it when you first had your pouch and go back to that. You can do it...you alread did! Just do it again! Best of luck to you as you get your next 20 off!!
   — snowlover