Malnutrition = feeding tube!?!??!

I had my Roux-en-y surgery April, 2011. I have lost 135 lbs and I am thrilled about that!! I am no longer diabetic, no more high BP or cholesterol, have much more energy (before I began getting sick... which seems to be all the time... will explain more later) and I love buying clothes that are 10 sizes smaller than before surgery.

I made one VERY big mistake after surgery and that was that I did not wait 30 min before and after eating to drink something. I didn't really think it was such a big deal until recently. One of the reasons they tell you not to drink before, during and after eating is because it will flush the nutrients being consumed too quickly. Two plus years later I now know it was a gigantic mistake... my pouch today is practically the same size as it was the day I had surgery... which means I am not able to eat or drink what is required as a WLS patient. I can go 24-36 hours without NEEDING to eat... I NEVER get hungry and drinking fills me up VERY quickly!! A eight ounce cup of water takes about an hour for me to drink... if I drink too much I feel sick and throw up. This has developed into having Bile Reflux which is worse than acid reflux which is like throwing up but nothing comes out except ... bile and that causes my throat to burn and can’t swallow! PLEASE... if you have not had the surgery yet BE SURE NOT TO DRINK 30 min before and after eating!! Please... learn from my lesson! So... after all that, I do have another reason for this post...

One big factor that happened after surgery is that my losing the weight made it apparent that I have Attention Deficient Disorder… because the surgery caused my estrogen levels to go down it became very clear! I started a medication trial January of this year and we haven’t been able to find the right combination yet. After seeing my surgeon last week he told me that the symptoms I am having that the ADD meds are treating won’t do any good because my body is not getting the protein and fluids needed. SO… I am gradually coming off the ADD meds so that when I have surgery on Dec 5^th (hysterectomy) and I receive an estrogen patch it will give a clearer picture as to what, if any, ADD meds will be needed.

Now for my biggest dilemma that I need feedback for….The surgeon told me that if I do not start getting 64g of protein and 64 oz of fluids in every day he is going to have to put in a feeding tube!!! YIKES… now that is scary!!! It is VERY VERY difficult for me to get 24 oz of fluids in each day, let alone 64!! The protein I have started to make it work through a protein shake that gives me 49g in 16 oz… it takes me about three hours to get the whole thing down – the other beauty of the protein shake is it also counts as 16 oz of fluids… now I only have to figure out how to get the other 50 oz in through the other 13 hours I am awake… well, its not even really 13 hours if you remove time before and after eating that I can’t drink… eating five mini meals a day takes another five hours off the top which brings it down to 8 hours left for drink and it takes about 30-45 min to each so there is another  4 hours leaving it to only 4 hours for me to drink 50oz… just seems IMPOSSIBLE!!! Since I get full on 8oz in an hour that means it will take five hours to get 48 oz in… oh and lets not forget, when I take the 22 pills throughout the day (vitamins and meds) that takes up room in the pouch and the fluids take even more time…

I am SO sorry this has became such a long post == Has anyone else had these type problems??? I am completely open to hearing any suggestions anyone would have.

And YES… all of this has caused my stress level and anxiety to get higher … coming off the psychotropic drugs right now is not ideal… but not much I can do with the hysterectomy right around the corner… ugggggg .. I REALLY NEED HELP!!!  It just makes me want to curl up and die… oops… cry… 

If you can't drink more than 8 oz in an hour, is your stoma too small?  What does your surgeon say?

I don't see how flushing nutrients out of the pouch quickly is a problem.  We don't absorb nutrients in our pouch anyway.  we absorb them in our small intestine.  Flushing them out of the pouch just gets them into the intestine where they will be absorbed sooner.

I don't see any reason not to drink for 30 minutes before eating, either.  Liquid can't flush out something you haven't even eaten yet.

Then why do you think most surgeons have recommendations of waiting 30-90 minutes between liquids and food? Do you think there might be something here that you are not aware of or not factoring in?  Kelly, I know you are very well versed in many areas of nutrition, but with all due respect, it worries me that someone might ignore their doctor's advice based on this conversation. Just trying to be cautious.

Because right after surgery we cannot eat or drink much. If we drink right before we eat you will feel full and not eat enough nutrients. The farther out you get the less liquids provide a full feeling. Since about 4 months out I don't worry too much about the 30 minutes before. I just make sure it's been a few minutes and I feel like my stomach is empty. 

Now the 30 minutes after is one I absolutely do not break. 

I don't know why some doctors recommend not drinking for 30 minutes before eating.  I've never heard of one recommending not drinking for 90 minutes before eating.  Many surgeons and dieticians say it's fine to drink right up until you begin to eat.  Why do you think they say that if there is something dangerous about drinking right before you eat?

I was also curious about this and asked my doctor out right at my 6 week post op.  I understood the after but not the before.  She said if fluid isn't filling you up and you can get the amount of food in you need to then there is no need to worry about before.  That she recommends 30 before and after as a habit so that people dont start drinking with meals and then later have weight regain when you can fit more food in cause your flushing it out to quickly.  I am still told not to drink 30 minutes after but she told me I could drink up till if that was the only way I was getting my fluid in.  For me it was more a schedule thing of getting in my vitamins, working out, and eating.  If I have to wait 30 minutes before then I couldn't eat for 30 minutes after my workout which would then put me to where I was getting ready for work and would push my breakfast out even longer.   I always say ask your doctor and follow what he says.  So far Kelly's advice has always been helpful and at least helped me start conversations with my nutritionist, PA, and Surgeon. 

I'm a week post op and my NUT told me it was ok to drink up until I ate as there was nothing to flush out. And to wait 20-30 min after so I didn't flush out food too fast.

I have also been full of of fluids and i am 8 months post-op and still cannot get in 64oz of fluid or it hurts if i try. I also take a lot of meds like 20 right now. I have been losing more weight than typical right now because of my lack of eating/drinking. I was down 4.4 lbs last week alone. Have you had an endoscopy to check for an ulcer and/or gastritis when i had similar symptoms fullness off of fluids it turned out i had gastritis and now i have an ulcer. Worth checking into. Sorry your going through all of this over 2 years later.

Thanks for replying MZLaura. Yes I did have and endoscopy done and that's when they diagnosed Bile reflux issues. There is a small hole in my stomach that is releasing acid ... Ugh!!! It is so frustrating. I hope you are doing ok now that you have a diagnosis. I just wish there was a pill to take to take care of the fluids!!! LOL

Thanks for raising this issue.

Have you asked your doctor how he expects you to get all that in, given the timeline? I think that is a very good question that he needs to answer.

Hope you are feeling better soon!