Question:
ATTENTION : ALL postops that had problem with eating too much please respond...
I went to the doctor today and I made sure that I mention to her just how much I can eat. This was my 8 week appointment, but I am really only about 7 weeks post op right now. I told her how I could eat 6 chicken nuggets at one meal, and she said how--"your going to stretch your stomach", and I told her that I was just that hungry and still had an appetite, and that other days I feel like I can't eat that much. She said where the new stomach "pouch" meets the intestine had "slothed off" and where that hole was for food to pass from the pouch to the intestine has gotten bigger or "slothed off". This means that I can eat more, BUT where if I eat 5 nuggets I still only absorb 2 OF THOSE. So, in other words I eat 5 only absorb 2 which is what I would absorb if I eat 2 nuggets. I said so that can be good right? and she said well you probably will never stretch your pouch out because it can't get full enough from the bigger opening allowing food to just pass right through. Apparently, this is a problem often with patients, and they don't know why. She assured me that I will still make it to goal weight. In fact, she said that they can do surgery to correct the larger opening, but she said the only reason that the patient had revision on the opening was due to "foul" smelling stools. It seems to me it could be bad because you can't or don't hold food in your pouch as long, due to the food just being able to pass right through. HAS ANYONE EVER HEARD OF THIS...I need to learn more about this. Can someone help me??? Thanks a bunch! — Patra R. (posted on July 24, 2003)
July 24, 2003
Some people don't get the benefit of the restrictive pouch because they
have an enlarged stoma (the part that connects the pouch to the intestines
expands and gets so big food flows from the pouch into that enlarged space,
so the patient doesn't get full as easily and can eat more). This happens
in a small percentage of patients. I'm not sure whether anyone has
developed a good surgical fix for it.<P>I'm afraid I would have a
hard time accepting the idea that, if I eat five chicken nuggets (which I
wouldn't do anyway -- too fatty, too carby, too processed), I only
"absorb" two of them. The math on that just does not compute.
That would mean that, as post-ops, instead of eating, say, 1800 to 2000
calories a day on maintenance, we could eat over 4000 calories and not
gain. It would mean you could eat 2,000 calories and lose. And that ain't
gonna happen.<P>I'd go over this ground with your doctor again. I'm
not sure how she knows you have an enlarged stoma at seven weeks out
without doing any scoping on you (ask her how she can tell that without a
scope). It may be an educated guess on her part, I don't know, but on the
other hand, the idea you're only absorbing 40 percent of what you eat is
rather wacky, and it would shake my overall confidence in my doc if he said
something so bizarre<P>Try eating denser foods to fill you up (such
as chicken breast, if you can), rather than soft foods that flow through
the pouch with ease. I think it's possible you don't have an enlarged
stoma at all; you may just be learning how easy it is to eat around the
pouch with certain kinds of foods, which is scary to all of us once we
realize it.
— Suzy C.
July 24, 2003
This is what is called a large stoma. Those that reach goal with this
problem have to really fight for it from what I have read on here. Yes you
are able to eat more food because it doesn't stay in the pouch because of
the large opeing so your whole intestine acts like a stomach. You have to
really watch what you eat with this and there are very few doctors that are
even willing to correct the problem. They usually say not much can be done
about it. Good luck. I am so sorry this has happened to you.
— Delores S.
July 24, 2003
I agree with Suzy C, how does your doctor know this without scoping you,
which is how the doctors determine if you have an enlarged stoma. Also,
how long is it taking you to eat 6 nuggets-is your meal 10 minutes long or
an hour? Any one of us could eat 6 nuggets if we took long enough to do
it. And, are you drinking with meals, which will just empty your pouch
quicker allowing you to fill it with more. Have you ever felt full from
eating food? If so, you may not have an enlarged stoma. Those that do
often say that they never feel full as food simply passes from their
esophogus thru the stoma with out taking a break to fill the pouch. And,
what type of surgery did you have (sorry, should have read your profile).
Those who have the DS( I mention this because you mentioned foul smelling
stools which can be a problem with some who have the DS), they do absorb
less of the food, but that is because most of their intestine is bypassed,
whereas with the RNY it depends on how much was bypassed. It also means
they supplement more and can eat more too than an RNY'er. The exact amount
that is absorbed, I'm not sure any doctor can say so with certainty. I've
never seen any studies to confirm this. Before you panic, ask to be scoped
for confirmation.
— Cindy R.
July 24, 2003
The OPENING is very important. If the stoma is 'too large' it renders the
pouch useless. This is a problem with the RNY; the DS bypass' this
problem. If, you are like most seeking WLS.. YOU chose to have WLS for the
'food' restrictions. IF you stoma is too large; and your pouch
non-functional... YOU have LOST a major tool in the WLS. YES your doctor
is right; at FIRST you will still loose the malabsorption part of your WLS
is STILL WORKING.. BUT and this is the big part... the malabsorption part
is what you have heard as the 'window' in WLS. the malabsorption part DOES
end eventually.. and that is where the importance of the pouch comes in..
MAINTENANCE!@!!~!! If you have no malabsorption and NO pouch
restrictions... where are you? technically like you were before surgery.
I have the problem; it was evident from DAY ONE post surgical...and I
brought it to my surgeons attention; both of us were 'new' and didnt know
what the heck was going on... BUT contrary to what you surgeon said about
'fixing' it... I would be surprised if she did. 99.9% of the surgeons out
that WILL NOT FIX IT> According to the bariatric association; which I
talked to personally; surgeons have had little luck in fixing it; so refert
their patients to 'diet and excerise' ALSO its very dangerous... to fix...
I am almost 3 years post and my original surgeon and my consult surgeon did
NOT want to touch it.
I have major problems in overeating... I was a volume eating prior to WLS;
and still 'overeat' now.. the MAJOR problem now is , I dont get 'full'...
My suggetsion; is get the DS if your pre op.. if available. If your POST
RNY with this problem, it can be a major heart ache. Can you loose?
YES... I have lost 150 pounds.. Did I 'get' to goal? hmmm chart weight
goals.. NO. could I have? maybe, but my eating intervered in that. My
body has 'maintained' me at what I call my body goal for over 2 years
now... but I have gained. I gained almost 20 before my TT. Which I lost
after wards...
BUT more than the gaining; its the 'mental' that you go thru. You expect
to have the food limiations after surgery.. and you dont. and that can be
hard to adjust too.
Everyone 'gushes' over carnie wilson; but what about Roseann BArr? Yes,
Roseann! she had WLS, she was the one that told Carnie about it; From what
little Ive heard about Roseann she may have a 'large stoma' problem.... Is
she thin? No, but she isnt back to her orignal weight.
If you are 7 weeks post... You will continue to loose - up until your
window' closes...
good luck.
— star .
July 24, 2003
Orginal poster here---I hope that I don't have an enlarged stoma, I can
and do feel full. I just feel like it takes more food to make me feel
full. Does that sound like an enlarged stoma? I sure hope not. Is there
a chance that the opening can get smaller with scar tissue and heal itself.
My doctor didn't call it an enlarged stoma and she didn't even scope me,
but the 5 and 6 chicken nuggets scared her, so I think she assumed. But I
do know that I can eat like some 4 and 6 month posties. Please tell me
that it is possible that it isn't enlarged.
— Patra R.
July 24, 2003
Hi Patra. You know, the one thing that no one has mentioned here is that
we don't know the size of your pouch. Most RNYers have a pouch that is
about 2-3 ounces, but I have read that some pouches can be from 1-8 ounces.
If you have a larger pouch, that would be why you can eat so many nuggets.
Just a thought. I would check with your surgeon about the pouch
size,though. :)
— Cheryl M.
July 24, 2003
Patra -- I have no answers...just good wishes for you. I sincerely hope
that it does not turn out to be an enlarged stoma & that your weight
loss will be successful.
Helen -- You mentioned in your answer to Patra that the malabsorption is
the weight loss "window" that disappears eventually. I've read so
much but I never knew this. I knew that the first year was when most weight
loss occurred but I just ASSumed that the reason it slowed later is that
our boidies adjust to the calorie restriction. Could you please explain
further? If the malabsorption stops around one year, why do WLS patients
have to take vitamin supplements for life? Or is still there but just not
enough to continue helping with weight loss?
— Barbara M.
July 24, 2003
I think you may have misunderstood the surgeon. My surgeon also warned me
after surgery that where they had made joins to my stomach and intestines,
scabs would form internally. Same for the stoma. At some point, these scabs
would "sloth off", which would possibly cause some darker than
normal stools. She was probably saying that now that the scabs have
"slothed off" the wounds internally, you would have a bit more
capacity, but don't overdo it or you will stretch your stoma out because it
is still in the process of healing. Your post struck me because my surgeon
used the words "sloth off" to describe these internal scabs
coming loose and passing out through the stool. I think I would talk to
your surgeon again and just clarify that this isn't what she was trying to
tell you.
— Greg P.
July 24, 2003
My 2 cents worth is that anyone who can eat 5 nugets 6 weeks post op has
not had a successful surgery. Your food just passes through which defeats
the small pouch. Were you transected. Your surgeon has a lot of splaining
to do. I would be furious.
— faybay
July 24, 2003
HI - I am 4 months post op and I still could not eat 6 nuggets. Right now,
I can eat 2 and, maybe, a bite of salad. My pouch holds between 3 and 4
ounces of food.
If at anytime you do not feel comfortable with your doc's response...go
back and talk to him again and have another person with you. This will
help to have an extra "set of ears" listening and perhaps more
questions will be asked and answered. If you are not satisfied, or you
think your surgery was botched....immediately, go see another surgeon! It's
ok to get 2nd, 3rd, 4th...opinions when it comes to our healthcare. Best
of luck to you, Patra.
— teresa M.
July 24, 2003
Orginal poster here again---Yes, I am transected and I have lost 40 pounds
in 7 weeks. Like I said my doctor never called it enlarged nor did she
scope me. Is it possible that when I ate the nuggets they may have filled
my esophagus? I've heard of that happening. I am just not going to except
that I am a total failure and that this surgery won't work for me. I am
freaking out a little here and need some more responses that can explain
what is going on. Can anyone else eat 6 nuggets, no fries, no drink, when
really hungry? This was at 4 weeks post op. I am now 7 weeks post op and
yesterday all I could eat is 1/2 chicken soft taco from Taco Bell and I was
full. And actually I know this is bad, but that is all I had yesterday,
because I was so freaked out from the doctor visit. I feel like if I have
a larger stoma than I may just have to starve myself, and I know that isn't
right, but I didn't go through all of this for nothing. And, by the way,
my doctor told me to drink with meal so I won't eat as much. I thought
that just turned your food into liquid and made it flush quicker. Thanks
for your responses.
— Patra R.
July 25, 2003
Are you drinking with your meal? I know a lady who at 6 weeks out could
eat an entire bologna sandwich and I was amazed. I kept thinking how could
she eat that much?? Then one day she said "I am can drink when I
eat", as if it were something that didn't work for her and none of the
rest of us couldn't drink. We pointed out that we could ALL drink, but
DON'T because you wash the food out of your stomach and make room for more.
How long after eating are you waiting to drink, ANYTHING. I mean a little
sip even?
— Michelle A.
July 25, 2003
I think if you had food sitting in your esophagus you'd be
choking.<P>I suggest you get a second opinion from another bariatric
doctor, if only to ease your growing concerns. IMHO, I just can't see why
anybody thinks or even suspects that you've got a surgical failure in your
case. Your weight loss is just fine for seven weeks out, and the fact you
could eat six chicken nuggets (over a still-unreported period of time),
when placed in perspective, just ain't this big a deal. Can you eat
anywhere near the volume you could eat as a pre-op??<P>When I was
able to finish an entire Lean Cuisine ravioli meal at three months out, I
certainly worried about it, but it did not herald a surgical failure in my
case. (I just cut the portion in half and ate it with a veggie burger down
the line, to keep my protein up, and moved on.) I sure am glad I didn't
ask, though, because I would've been freaked out by people insisting I had
a surgical failure based on that incident (especially if one of them was my
own doc). While your concern is legitimate, I think you're surrounded by
over-reactions. Hang in there -- eat, for cryin'outloud! -- drink (not
with your meals, though) -- and keep up the good work. I predict you will
be just fine despite all of us. ;-) JMHO.
— Suzy C.
July 25, 2003
Some days I can eat lots, other days, like a fresh post-op. And that seems
to be the norm for us. BUT the relaxed stoma is coming out of hiding, more
& more. I have sat thru 3 consultations in a row with someone who was
being told (by other than their own surgeon, for whom there was "no
problem") that their stoma was XXmm, not the XX mm it should be,
sketch, thus, so it shoudl work so, but really works so. Their shock is
palpable. After 2-3 yrs of assuming they were crazy, they hear for the
first time that it is a mechanical flaw. These don't fix easily, but it is
half the battle to know that it might have just adapted to the same size as
the intestine. It's much better than the 100X per day thought, "My
gosh, I'm such a diseaster that I outate the surgery". I will
recommend that you tune into the Grad list, even if you are new. As more
people deal with this, and their horror at the way they have been treated,
perhaps you can follow their progress. Grads is for people one or more
years out to POST. Anyone can lurk and I
highly recommend it.
http://groups.yahoo.com/group/Graduate-OSSG
— vitalady
July 25, 2003
I think a member or two might have gingerly mentioned not too long ago that
there is a problem that sometimes happens with our surgeries that few docs
acknowledge, and seldom advise of as a possible occurrence.
I think it is now time to come out of the closet and shine a bright light
on
this dirty little secret. Last week I flew to Seattle for an endoscopy and
consult with Dr. Ki Oh bcuz I have NEVER felt much restriction from my
pouch. I
have been SO frustrated when others talk about being absolutely stuffed on
3
bites of something. I have not been stuffed on even 10 times that much. My
first
solid (soft) food meal was 12 oz (some are supposed to eat only 1 oz; my
doc
said 4 oz) and I COULD have eaten more--I was not full, or even satisfied.
I
stopped eating bcuz I knew I wasn't supposed to be able to eat that much.
My surgeon turned a deaf ear to my complaints and pleas. He didn't exactly
say it was "all in my head." Members of support groups, both
online and in
person did, tho, intimate that it had to be "head hunger." And
that was both
hurtful and discouraging. I have spent the better part of the past year and
a half
believing that I am no better now than I was pre-op: unable to control the
cravings and eating more than I should. And hating myself and my failure
quite
thoroughly.
Well, guess what? The scope showed my stoma is 3 times the size it should
be.
Therefore pretty much rendering my pouch non-functional. Nothing wrong with
the POUCH: it's still just 15 cc. But the stoma is too wide and doesn't
keep
the food in the pouch. It just pours right thru into my intestine; hence,
no
fullness, no satiety, and the urge to keep eating and eating and eating.
Becuz the stoma has a tendency to relax/stretch somewhat over time of its
own
accord, it is extremely important that the bariatric surgeon make it as
small
as possible. In Dr. Oh's opinion, judging by my stoma size after a little
less than 2 years, it was probably made a bit too large in the first place.
The
rest of the bad news is that the anastomosis is so close to my esophagus
that
there is absolutely no room to do anything about it: can't move it, or put
a
silastic ring on it, nothing. I am doomed to be hungry the rest of my life.
Am I
mad? Try royally PI - - ED ! Am I going to do anything about it? Don't
know.
Right now, I'm just struggling to accept the facts of life, so to speak. I
am
relieved that the stoppage of my weight loss is not "all my
fault." But I am
just devastated that I will probably NEVER be able to get to goal -- at 70
lbs
more to go. I can go more distal, which will give me some greater
malabsorption, but it won't do a thing about the large stoma or the
hunger.
Another misleadig "fact" that was presented by my surgeon prior
to my
proximal RNY was that the average weight loss is about 70-75% of excess
weight. Dr.
Oh says that that figure is for patients with DISTAL procedures. The amount
for
proximals is about 50-55% net loss bcuz of the usual amount of regain.
So, dear friends, let this be a clarion call warning. If you are struggling
with slow or stopped weight loss, or regain; if you are constantly hungry;
if
you have never or have at some point become unable to feel satisfied or
full
after a meal (a normal meal for a bypass patient)--maybe you should get
yourself
scoped and see what's going on with "the mechanics" as Michelle
calls them.
Sometimes something can be done about it. Sometimes, as in my case, not.
And PLEASE pass this info on to any other lists you subscribe to, so the
word
gets out. I would that not one other person suffers what I have gone thru
for
so many months, thinking all kinds of terrible things about myself, my
lousy
willpower, my lack of moral fiber, my character defects, etc etc. If you
know
a pre-op considering this surgery, please tell him or her that this is a
possible outcome, and that they should query their surgeon closely, in
advance,
about what size stoma will be made, and where, and what can be done should
there
be a failure or relaxation or stretching of the stoma. They should know
that
if a doc says that would not happen, he's not telling the truth or he's got
his
head in the sand. And if there are any pre-ops lurking on this list, be
warned as well.
I am not saying that I would not have had the surgery had I known this was
a
possibility. But I would have CERTAINLY done more and better research, and
would have made sure that my surgeon would guarantee that my
"mechanics" were
constructed in such a way that it would not be impossible to rectify the
problem.
Carol A
— faybay
July 27, 2003
IF you find you actually DON'T have an enlarged stoma (which I hope is the
case) I suggest strongly that you do a search on POUCH RULES, which is
written by a doctor with 33(?) years experience that gives specific rules
to live by relating to drinking until full before eating, not drinking
until about 1/1/2 hours post-eating, etc. Hope it all works out for you!
— Postop_nurse
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