X-Post: Revision causing bigger than normal RNY pouch?

 Anyone else have this?  

I was quite surprised at my 4 mth follow up appointment to find out that I have a larger than normal RNY pouch  what?!?!?!  

This came up because I was telling my doc how much my appetite and hunger pangs have increased which has been really worrying me.  He told me that that was normal as I have a bigger than normal RNY pouch due to the extensive scarring and damage to my stomach tissue caused by the LapBand I had for 6 years.  He also remembers having a very hard time visualizing the bottom of my esophagus and seeing that that is full of scar tissue as well from the reflux caused by the LapBand.  

He said that my stomach is significally smaller than my original stomach, but that my pouch is wider and longer than a normal RNY patient because he had to navigate around the scar tissue and had to get to an area that the staple gun would penetrate so that I didnt have any leaks which makes sense, but just was not what I was expecting to hear.  

Unfortunately, the pouch size is not noted on my OR report so I have no idea how big it is and at this point, he can't remember how big he ended up making it.  I would venture to guess that I'm somewhere between a RNY pouch and sleeve-sized stomach.

So, any suggestions on figuring out how much I should be eating at 4 1/2 months (18 weeks) out?  I'm still hungry after a "normal" RNY portion, but I don't want to eat too much and run into problems with that.  I also don't want to start "grazing" between meals.  As it is, I'm supposed to be eating 6 small meals a day to keep my blood sugars at a good level.  Protein shakes no longer fill me up, they just go right on through, so does cottage cheese, which was my biggest "go to" food.

I guess what I am trying to figure out is how much to eat so I am not still hungry but so that I will continue to lose and not over eat and stretch out my pouch. 

I am, however, making sure I am getting in all of my vitamins and supplements, I haven't slacked on that because I know if I do, especially burning the candle at both ends, I will get sick. 

For the last few weeks I have been bouncing between 183 - 187 and just can't seem to get below 183.  I KNOW I am not done losing and that some of this "stall" for lack of a better word is MY fault because I have not been exercising and have only been getting in about 50-60 grams of protein a day if I'm lucky.  

I'm working both jobs right now, and covering for a lady whose husband is home on Hospice, so I am working 12-14 hour days and until she comes back to work, exercise really isn't realistic. I'm dead tired at the end of the day and can barely drag my butt out of bed in the mornings, and my crazy schedule is why I'm not exercising now and not eating the way I should be.  

Oh yeah, I asked him about my ideal weight and he said I could go as low as 131, but he would like to see me at 145-150 lbs.  He said he would be happy with that and he thinks I will be too.  

I am open to suggestions!  

 Interesting....

I can't comment about the pouch size... But goal weight - let your body decide!  Don't just be "happy" with your weight - be "ecstatic"!!!  I also picked 150 for my goal weight, but knew I wasn't done losing, gave myself 5 lb increment goals until I hit 125 and it was pretty interesting, because that's exactly when I stopped losing.  I didn't even try.  A few months later, I lost 2 more lbs and kept that off for well over a year, and probably could have lost more, but that really was enough for me.  I've "bounced back" up to 132-134... I was ecstatic at 125!  Ok where I'm at now, but not really happy.  I believe my "happy weight" is 127-129.  

You have some challenges with the bigger pouch, and it's really hard when you don't know exactly how big it really is.  The only way to find that out is to have a good Dr do a scope on it, which they're not going to unless you have a problem.  

My suggestion is to eat dense meat.  You will still need to measure and make sure you're not overeating, because your pouch will allow it, but it should keep you "satisfied" longer.  

I hope others have some good suggestions for you!

** sorry if multiple reposts, but OH was only showing the top line in my reply so I retyped this. . again**

 Thanks!

"Don't just be "happy" with your weight - be ecstatic!!!"  --  This is great advice!  I am still thinking I would like to be 130-135 but we will see where I end up.  I figure if I just keep doing the same thing, my body will eventually stop somewhere, hopefully in the range of my "happy weight" 

Kelly and Lora posted on my thread over on the RNY board and also suggested that I stick with dense protein and drink more fluids, so I am going to take their advice and do just that.  Kelly also suggested I wait closer to 60 minutes after I eat to start drinking and than add in extra water, so I will adopt that too and see how it goes, hopefully it will make a difference!

I am thinking based on something Lora said that maybe I'm not actually "hungry" I am thirsty after I eat and am just not interpreting what my body is telling me correctly. 

I don't have it but I've heard about it happening. Sometimes you can't get the surgery you want as a revision because of scar tissue. That's why a lot of people say "think twice, cut once."

"I would venture to guess that I'm somewhere between a RNY pouch and sleeve-sized stomach."

Um, sleeves are smaller than pouches. A typical sleeve holds 4-6 oz. of food and a typical pouch holds 8-12 oz.

 
I wanted the DS but wasn't a candidate for that because of other health issues I have, plus my reflux was so extreme and I have a lot of esophageal damage and scarring, and that was part of what ruled me out for the DS and the VSG.

The RNY cured the reflux, which I can't be thankful enough for! I also knew that the scar tissue from the LapBand would be a factor in the revision surgery.  I just hadn't considered I would have a larger pouch because of it. 

That's interesting info on the VSG vs RNY pouch sizes.  I have been told that the RNY pouch is about the size of an egg and the VSG pouches are about the size and shape of a banana.  Though I have to say, I didn't do a lot of VSG research when I was told that that surgery wasn't an option for me either because of my reflux. 

Thanks for the info!

Yeah, people say that a VSG pouch is the size and shape of a banana... but people say all sorts of things! LOL

It's actually more the shape of a hockey stick and it starts out as wide as a Pilot pen (but longer) and generally grows to twice that, so maybe as wide around as a permanent magic marker.

The RnY pouch as been described as the size of an egg or the size of a walnut. It made from a different part of the stomach though so it's also stretchier than a sleeve.

The big thing with RnY is the size of the stoma though because that's what keeps the food in your pouch long enough to feel full.

 
That makes sense!  

I experienced hunger early out and researched some and GERD can mimic the feeling of hunger. I went back on prilosec and this has helped some. I agree with above....eat dense protein...also if you are only getting in 50-60 oz of protein I would seriously add in a shake....100 extra calories that may not fill you up BUT will add to protein amt...experiment...

Good luck....it may not be ideal but keep on keeping on!

~~Jennifer

 
Thanks, Jennifer!