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October 17, 2010 at 2:12 pm #30410xxxcazzaxxxMember
hiya everyone its me again. :help:
i was wondering if anyone knows how you can tell if your stretching your pouch, as i have been eating what i thought was about 2 tbsp of food at meal times but found out yesterday that i am actually eating about 4tbsp, (the spoon was bigger than i thought), i havent been sick or felt sick and had no pain. my sister has got me worried as she says purhaps i have stretched my pouch, i havent weighed for 2 wks so dont know if i have lost anything this fortnight but before that i was loosing well.
hopefully someone knows the answer to my question. i am very worried.
:noidea: :noidea: :noidea:October 17, 2010 at 4:19 pm #39723LorraineMember
I think the quantity of what you eat depends on the consistancy. For example: if you eat a pot of low fat custard it is about 4 tablespoons but if you eat a cracker and cheese although it is only 2 tablespoons in volume it is much more filling.
When I went for my checkup with the dietician she said to stop having wheatabix or porrige for breakfast and try having fruit and fibre and I find I can’t eat as much. Likewise last night I had risotto and could only manage a couple of tablespoons yet the day before I had a whole tin of Heinz Lentil soup. It really depends on how easily food slides down and how long it stays in your tummy.
I am sure you are eating the right amount, too much and you will be throwing it up, so worry not!
LorraineOctober 17, 2010 at 5:30 pm #39724BrainsMember
Try not to worry I know it is hard but we all feel the same as you. As you know I am nearly four months after bypass. I worry constantly am I eating enough – am I eating too much!! If you eat too much your tummy would certainly hurt you and also you would end up bringing it back by being sick – or it may bypass your tummy and go straight through you.
When do you have a review appt. I have only had one so far but have one begining of Nov. If you really are worried ring and speak to the team.
We are all learning. Please take care xx :grouphug:October 17, 2010 at 7:33 pm #39725xxxcazzaxxxMember
thanks for that my first review is on the 1st nov so im sure i will find out loads then, i will make sure to ask alot of questions. i know deep down that if i was eating to much my body would have told me by now,
is anyone else at chichester on the first, it would be lovely to some of u, im there at 11October 19, 2010 at 3:18 pm #39718mandylMember
dont worry cazza,
your far too new to worry about that. i worry some days(nearly a yr out) but then eat something feel full and its fine.June 10, 2011 at 5:19 am #39719Ms EllieMember
Just thought Id post this link for information purposes.June 11, 2011 at 9:00 am #39722RennMember
Hi Ms Ellie
Sounds like me loosly following the GI Diet books by Rick Gallop since 3 mths out has helped me avoid dumping and sickness as it has. Thanks very much for this posting Ms Ellie it’s a must for all us bypassers.
I will certainly recommend it to my clients.
Great to see everyone at Borehamwood. Wonderful evening hosted by our very own beautiful knowlegeable Elena. She’s an inspiration to us all how her and Twinkle, Andy and Paul are always there for us all and so supportive. We need you thanks for the effort. They drove 114 miles one way to get to my Fareham group. How’s that for dedication! Thanks a million guys and gals!
Renn (Madeleine)June 13, 2011 at 8:02 pm #39720Ms EllieMember
Your so very welcome Renn I shall look forward to seeing you again soon down in fareham.
Much love to you and bill xxxxJuly 7, 2011 at 4:39 pm #39729
POUCH RULES (wish I could follow them)
A common misunderstanding of gastric bypass surgery is that the pouch causes weight loss because it is so small, the patient eats less. Although that is true for the first six months, that is not how it works. Some doctors have assumed that poor weight loss in some patients is because they aren’t really trying to lose weight. The truth is it may be because they haven’t learned how to get the “satisfied” feeling of being full to last long enough.
HYPOTHESIS OF POUCH FUNCTION: We have four educated guesses as to how the pouch works:
1) Weight loss occurs by actually “slightly stretching” the pouch with food at each meal or;
2) Weight loss occurs by keeping the pouch tiny through never ever overstuffing or;
3) Weight loss occurs until the pouch gets worn out and regular eating begins or;
4) Weight loss occurs with education on the use of the pouch.July 7, 2011 at 4:40 pm #39730
PUBLISHED DATA: How does the pouch make you feel full? The nerves tell the brain the pouch is distended and that cuts off hunger with a feeling of fullness. What is the fate of the pouch? Does it enlarge? If it does, is it because the operation was bad, or the patient is overstuffing themselves, or does the pouch actually re-grow in a healing attempt to get back to normal? For ten years, I had patients eat until full with cottage cheese every three months, and report the amount of cottage cheese they were able to eat before feeling full. This gave me an idea of the size of their pouch at three month intervals. I found there was a regular growth in the amount of intake of every single pouch. The average date the pouch stopped growing was two years. After the second year, all pouches stopped growing. Most pouches ended at 6 oz., with some as large at 9-10ozs. We then compared the weight loss of people with the known pouch size of each person, to see if the pouch size made a difference. In comparing the large pouches to the small pouches, THERE WAS NO DIFFERENCE IN PERCENTAGE OF WEIGHT LOSS AMONG THE PATIENTS. This important fact essentially shows that it is NOT the size of the pouch but how it is used that makes weight loss maintenance possible.July 7, 2011 at 4:41 pm #39731
HOW DO WE INTERPRET THESE OBSERVATIONS?
POUCH SIZE: By following the “rules of the pouch”, it doesn’t matter what size the pouch ends up. The feeling of fullness with 1 ½ cups of food can be achieved.
OUTLET SIZE: Regardless of the outlet size, liquidly foods empty faster than solid foods. High calorie liquids will create weight gain.
EARLY PROFOUND SATIETY: Before six months, patients much sip water constantly to get in enough water each day, which causes them to always feel full. After six months, about 2/3 of the pouch has grown larger due to the natural healing process. At this time, the patient can drink 1 cup of water at a time.
OPTIMUM MATURE POUCH: The pouch works best when the outlet is not too small or too large and the pouch itself holds about 1 ½ cups at a time.July 7, 2011 at 4:42 pm #39732
THE MANAGEMENT OF PATIENT TEACHING AND TRAINING: You must provide information to the patient pre-operatively regarding the fact that the pouch is only a tool: a tool is something that is used to perform a task but is useless if left on a shelf unused. Practice working with a tool makes the tool more effective.
NECESSITY FOR LONG TERM FOLLOW-UP: Trying to practice the “rules of the pouch” before six to 12 months is a waste. Learning how to delay hunger if the patient is never hungry just doesn’t work. The real work of learning the “rules of the pouch” begins after healing has caused hunger to return.
PREVENTION OF VOMITING Vomiting should be prevented as much as possible. Right after surgery, the patient should sip out of 1 oz cups and only 1/3 of that cup at a time until the patient learns the size of his/her pouch to avoid being sick. It is extremely difficult to learn to deal with a small pouch. For the first 6 months, the patient’s mouth will literally be bigger than his/her stomach, which does not exist in any living animal on earth.
In the first six weeks the patient should slowly transfer from a liquid diet to a blenderized or soft food diet only, to reduce the chance of vomiting.July 7, 2011 at 4:42 pm #39733
REASSURANCE OF ADEQUATE NUTRITION
By taking vitamins every day, the patient has no reason to worry about getting enough nutrition. Focus should be on proteins and vegetables at each meal.
Regardless of lack of hunger, patient should eat three meals a day. In the beginning, one half or more of each meal should be protein, until the patient can eat at least two oz of protein at each meal.
In our study, we noticed some patients had intense hunger cravings which stopped when they eliminated artificial sweeteners from their diets.
Rules are made to be broken. No biggie if the patient drinks with one meal ? as long as the patient knows he/she is breaking a rule and will get hungry early. Also if the patient pigs out at a party? that’s OK because before surgery, the patient would have pigged on 3000 to 5000 calories and with the pouch, the patient can only pig on 600-1000 calories max. The patient needs to just get back to the rules and not beat him/herself up.July 7, 2011 at 4:43 pm #39734
Fluid loading is drinking water/liquids as quickly as possible to fill the pouch which provides the feeling of fullness for about 15 to 25 minutes. The patient needs to gulp about 80% of his/her maximum amount of liquid in 15 to 30 SECONDS. Then just take swallows until fullness is reached. The patient will quickly learn his/her maximum tolerance, which is usually between 8-12 oz. Fluid loading works because the roux limb of the intestine swells up, contracting and backing up any future food to come into the pouch. The pouch is very sensitive to this and the feeling of fullness will last much longer than the reality of how long the pouch was actually full. Fluid load before each meal to prevent thirst after the meal as well as to create that feeling of fullness whenever suddenly hungry before meal time.July 7, 2011 at 4:44 pm #39735
Around this time, our patients begin to get hungry between meals. THEY NEED TO BATTLE THE EXTRA SALT INTAKE WITH DRINKING LOTS OF FLUIDS IN THE TWO TO THREE HOURS BEFORE THEIR NEXT MEAL. Their pouch needs to be well watered before they do the last gulping of water as fast as possible to fill the pouch 15 minutes before they eat.
INTAKE INFORMATION SHEET AS A TEACHING TOOL
I have found that having the patients fill out a quiz every time they visit reminds them of the rules of the pouch and helps to get them “back on track.” Most patients have no problems with the rules, some patients really struggle to follow them and need a lot of support to “get it”, and a small percentage never quite understand these rules, even though they are quite intelligent people.
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