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July 7, 2011 at 4:44 pm #39736
THE IDEAL MEAL FOR WEIGHT LOSS
The ideal meal is one that is made up of the following: ½ of your meal to be low fat protein, ¼ of your meal low starch vegetables and ¼ of your meal solid fruits. This type of meal will stay in your pouch a long time and is good for your health.
VOLUME VS. CALORIES
The gastric bypass patient needs to be aware of the length of time it takes to digest different foods and to focus on those that take up the most space and take time to digest so as to stay in the pouch the longest, don’t worry about calories. This is the easiest way to “count your calories.” For example, a regular stomach person could gag down two whole sticks of butter at one sitting and be starved all day long, although they more than have enough calories for the day. But you take the same amount of calories in vegetables, and that same person simply would not be able to eat that much food at three sittings ? it would stuff them way too much.July 7, 2011 at 4:45 pm #39737
It is natural for quite a few people to use the rules of the pouch and then to tire of it and stop going by the rules. Others “get it” and adhere to the rules as a way of life to avoid ever regaining extra weight. Having a support group makes all the difference to help those that go astray to be reminded of the importance of the rules of the pouch and to get back on track and keep that extra weight off. Support groups create a “peer pressure” to stick to the rules that the staff at the physician’s office simply can’t create.
TEETER TOTTER EFFECT
Think of a teeter totter suspended in mid air in front of you. Now on the left end is exercise that you do and the right end is the foods that you eat. The more exercise you do on the left, the less you need to worry about the amount of foods you eat on the right. In exact reverse, the more you worry about the foods you eat and keep it healthy on the right, the less exercise you need on the left. Now if you don’t concern yourself with either side, the higher the teeter totter goes, which is your weight. The more you focus on one side or the other, or even both sides of the teeter totter, the lower it goes, and the less you weigh.July 7, 2011 at 4:46 pm #39738
A much more common problem is patients who after a year or two plateau at a level above their goal weight and don’t lose as much weight as they want. Be careful that they are not given the “regular” advice given to any average overweight individual. Several small meals or skipping a meal with a liquid protein substitute is not the way to go for gastric bypass patients. They must follow the rules, fill themselves quickly with hard to digest foods, water load between, increase their exercise and the weight should come off much easier than with regular people diets.
1. The patient needs to understand how the new pouch physically works.
2. The patient needs to be able to evaluate their use of the tool, compare it to the ideal and see where they need to make changes.
3. Instruct your patient in all ways (through their eyes with visual aids, ears with lectures and emotions with stories and feelings) not only on how but why they need to learn to use their pouch. The goal is for the patient to become an expert on how to use the pouch.July 7, 2011 at 4:47 pm #39739
1) Use thick barium to confirm the staple line is intact. If it isn’t, then the food will go into the large stomach, from there into the intestines and the patient will be hungry all the time. Check for a little ulcer at the staple line. A tiny ulcer may occur with no real opening at the line, which can be dealt with as you would any ulcer. Sometimes, though, the ulcer is there because of a break in the staple line. This will cause pain for the patient after the patient has eaten because the food rubs the little opening of the ulcer. If there is a tiny opening at the staple line, then a reoperation must be done to actually separate the pouch and the stomach completely and seal each shut.
2) If the outlet is smaller than 7-8 mill, the patient will have problems eating solid foods and will little by little begin eating only easy-to-digest foods, which we call “soft calorie syndrome.” This causes frequent hunger and grazing, which leads to weight regain.July 7, 2011 at 4:47 pm #39740
1) LACK OF TEACHING
An excellent example is a female patient who is 62 years old. She had the operation when she was 47 years old. She had a total regain of her weight. She stated that she had not seen her surgeon after the six week follow up 15 years ago. She never knew of the rules of the pouch. She had initially lost 50 lbs and then with a commercial weight program lost another 40 lbs. After that, she yo-yoed up and down, each time gaining a little more back. She then developed a disease (with no connection to bariatric surgery) which weakened her muscles, at which time she gained all of her weight back. At the time she came to me, she was treated for her disease, which helped her to begin walking one mile per day. I checked her pouch with barium and the cottage cheese test which showed the pouch to be a small size and that there was no leakage. She was then given the rules of the pouch. She has begun an impressive and continuing weight loss, and is not focused on food as she was, and feeling the best she has felt since the first months after her operation 15 years ago.July 7, 2011 at 4:49 pm #39741
Depression is a strong force for stopping weight loss or causing weight gain. A small number of patients, who do well at the beginning, disappear for awhile only to return having gained a lot of weight. It seems that they almost on purpose do exactly opposite of everything they have learned about their pouch: they graze during the day, drink high calorie beverages, drink with meals and stop exercising, even though they know exercise helps stop depression. A 46 year-old woman, one year out of her surgery had been doing fine when her life was turned upside down with divorce and severe teenager behavior problems. Her weight skyrocketed. Once she got her depression under control and began refocusing on the rules of the pouch, added a little exercise, the weight came off quickly. If your patient begins weight gain due to depression, get him/her into counselling quickly. Encourage your patient to refocus on the pouch rules and try to add a little exercise every day. Reassure your patient that he/she did not ruin the pouch, that it is still there, waiting to be used to help with weight control. When they are ready the pouch can be used once again to lose weight without being hungry.July 7, 2011 at 4:50 pm #39742
4) TRUE NON-COMPLIANCE:
The most difficult problem is a patient who is truly non-compliant. This patient usually leaves your care, complains that there is no ‘connection’ between your staff and themselves and that they were not given the time and attention they needed. Most of the time, it is depression underlying the non-compliance that causes this attitude. A truly non-compliant patient will usually end up with revisions and/or reversal of the surgery due to weight gain or complications. This patient is usually quite resistant to counselling. There is not a whole lot that can be done for these patients as they will find a reason to be unhappy with their situation. It is easier to identify these patients BEFORE surgery than to help them afterwards, although I really haven’t figured out how to do that yet? Besides having a psychological exam done before surgery, there is no real way to find them before surgery and I usually tend toward the side of offering patients the surgery with education in hopes they can live a good and healthy life.This rewrite was done exclusively for the people of this spotlight obesity support group. It should not be sold for any reason. “Dummies” version rewritten by Sally Perez Original article written by: Mason. EE, Personal Communication, 1980. Barber. W, Diet al, Brain Stem Response To Phasic Gastric Distention.Am J. Physiol 1983: 245(2): G242-8 Flanagan, L. Measurement of Functional Pouch Volume Following the Gastric Bypass Procedure. Ob Surg 1996; 6:38-43 Rosemurgy, A.July 7, 2011 at 4:53 pm #39743
Now, here is the caveat: Some of the information here has not been updated and therefore seek and take the advice of your Bariatric Team.
Hope it helps at least one person out there. I like to know the ins and outs of the reasoning behind most things and it has helped me understand a bit better. Not a guru on it tho’ JanifredJuly 7, 2011 at 8:48 pm #39728kathcMember
What an interesting read thanks .
Katherine , x
Sent from my iPhone using WLS FORUMJuly 7, 2011 at 8:59 pm #39721stilltryingsohardMember
teeter titter totter
I first learned that in TTT training 15 years ago
it still holds true today
thank you for the time & effort you have taken to post this
knowledge is power!!!July 8, 2011 at 9:34 am #39717LaurenKeymaster
Interesting.July 10, 2011 at 9:15 am #39726PinkdancerMember
Wow – interesting i am going to print this out and put it by my bed with my other book that i read snippets out of when i feel the need for a little bit of a pep talk.
Definitely going to try the water loading seems to make sense to me and my pouch ( need to think of a name for it maybe Barri !!)
Thanks for sharing this.July 10, 2011 at 5:03 pm #39744
Pinkdancer, you are most welcome. It took a while to post and I wasnt sure if there was a limit on the stuff you could post in one hit.
I am still exploring ways and means for my RNY and think I will try finding out about a fobi ring. Its called Banded RNY. I can only find one surgeon who does it at the mo and he is Michael van den Bossche. Anyone out there knows about this procedure? JanJuly 10, 2011 at 5:03 pm #39745
Why Barri?May 1, 2012 at 4:57 pm #39747charabancMember
Can anyone tell me where my new pouch is?
I am asking so I know if the pain I am getting is from pouch or pipe work?
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