01 June 2010

Take Care of Your Pouch and It Will Take Care of YOU..

Last week I received a stern warning from my surgeon about overeating and stretching the small pouch.
There was no joking about the subject, and he was seriously considering doing a barium esophogram at that point.. reason being is that I had a weight gain and I told him I could still eat a pretty good amount (2 slices of pizza).

At that moment, it became VERY CLEAR to me, that maintaining good pouch size and controlling head hunger will be the key to a successful weight loss.

The doc indicated that hewould give me a small fill, BUT that I need to adhere to the six small meals a day rule and respect the pouch volume.  If I had any pouch enlargement (which only the barium esophogram would show) there is the likelihood that by following these eating requirements, the pouch could return to normal size.  Just one bit of information (I did not experience any reflux or other adverse signs) so this supported his thinking that I was pushing the limits of my pouch size by eating larger amounts than prescribed.

So I went home and did my research (because I am a nerd like this..)  and came across this .. Article on Pouch Enlargement  which merely confirmed everything the doc told me.

Here is but a small excerpt that supports our discussion.

Pouch enlargement embraces the concept of concentric pouch dilation [10]. The stomach wall stretches significantly. The band is pushed down as a result of the high pressure exerted by the dilated pouch. As a rule, complete obstruction is not associated with this entity.  Therefore, it should not be considered a surgical  emergency.  The etiology of this complication can be attributed to both the patient and the surgeon. Factors linked to the patient responsibility are mostly chronic overeating and soda consumption [10]. Perception often is distorted, and the concept of ‘‘overeating’’ needs to be redefined after the surgery. Overeating after LAGB placement means the ingestion of more than 4 oz of food per meal.  With regard to the surgeons accountability, we believe that the adjustment technique is critical. Band  overfilling is clearly associated with the development of pouch enlargement. For that reason, we advocate the practice of tailored adjustments. Interestingly, we realized that 28% of the patients in our series presented to our office requesting an adjustment mainly for the lack of restriction. No other symptoms were present. These patients would have undergone an adjustment according to the ‘‘office adjustment’’ protocol [20]. Instead, complete band deflation was indicated. We strongly believe that tailored adjustments allow early diagnosis and treatment of pouch enlargement.  Early diagnosis has enormous implications for the success of further treatments.
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So for me.. I will be measuring my 4 ozs for each of my six meals.. no more guessing, no more gorging.. I have had my scare.. and have seen the light... be well..

13 comments:

  1. Scary stuff, I will keep this in mind. Thanks for the info.

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  2. Thanks, Barbara. It's a cold slap of reality, and I know it was good for me to read. I hope you're well and hanging in there.

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  3. Thank you for posting this. This is something I really need to keep in mind. :)

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  4. I too have slipped a couple of times.... like when eating a sandwich I always try to cut it in half and only put half on my plate. But have caught myself snacking on the other half..... so now I wrap the uneaten half up and go ahead and put it in the fridge ;-) Anyone that says having a band is the easy way out to weight loss hasn't walked a day in my shoes...lol

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  5. I had a similar conversation with one of the nurses at my clinic yesterday. I feel like the idea of stretching the pouch (I hate that term...what am I? A kangaroo??) is always on my mind and I live in fear of it, and yet every time I eat I'm certain that THIS is the time I've done it! So yes...my measuring cup is on the table.

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  6. Wow...I too am guilty. I've been leaving it up to my appetite to tell me when I start feeling full and that clearly isn't wise. Is the 4 oz. volume or weight...they're not necessarily the same thing, right???

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  7. Thanks for that Fluffy has a post on her blog on it to. So what you are saying is lack of restriction is not a good enough reason for a fill??? There has to be other signs too???

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  8. I am really worried that I have stretched my pouch. I am doing the 5 day pouch test starting today to see if that makes a difference. Hopefully I will see a big change or I am goingt to ask for a barium swallow at my next appointment. Thanks for the information.

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  9. I got this same lecture on my last visit. I said I was eating at least a cup at my meals and the doc totally freaked out. I am now measuring and paying closer attention! Thanks for posting this article!!

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  10. Very interesting...with this last fill to 6 cc's, its hard for me to get in a cup of food.

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  11. I also would like to know if the 4 oz is by volume or weight?

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  12. I believe most people will actually feel if they are stretching their pouches because they will have that "after Thanksgiving", way too full feeling. Eating too much too quickly is really a culprit of pouch stretching. The band only delays stomach emptying by something like seven minutes. We feel full because of the satiaty receptors being activated (that's the theory anyway), and not because there's actual food there. Point being, if you eat slowly (and of course watch portion size), you most likely won't stretch your pouch, because your pouch is actually emptying as you eat.

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  13. wow scary stuff! I hadn't even considered this but will now go home and measure everything. Thanks so much forthis post now if you could just cure my grazing everything would be sweet.

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