Can you help a new VSG having problems?

Could you offer any advice or support to a friend of mine? Over here in the UK we don't get as many VSGs done as in the US so I wondered if my OH friends could help! Is what she is experiencing the norm? And temporary?

She is on solid foods now at over a month post-op (not sure of exact timing but as per her doc's instructions)  and can eat ony 3-4 bites at a time and gets fiercely hungry an hour later. That's annoying but manageable when she is at home, but a real problem when at work. And it's very difficult to eat a sustaining amount of food in a 15 minute break when she has to eat so slowly.

She now finds that VSG patients can dump just like bypass patients do. She is told that this is not because the pyloric valve has been bypassed or removed but because the small stomach can't hold or churn food for very long, so it gets dumped into the intestines quickly, causing a blood glucose explosion and extremely unpleasant symptoms (hot, sweaty, dizzy, very nauseated). It happens to her if she overeats  (she hasn't yet noticed any stop signals), eats too fast, or eats anything with more than 5 grams or so of sugar in it. As a result, she is now going through a very trying trial-and-error process to find foods that she can tolerate. At times she says she is almost afraid to eat because she dreads the dumping so much.

Any advice gratefully  received.  Kate

You don't post any details about what she's eating  - but it sounds like she's eating the wrong things.  I base this on 2 points you make:

 

1.  She is hungry an hour later

2.  She is experiencing reactive hypoglycemia (not "dumping" proper like RNY experience but more rapid stomach emptying)

 

Look up an excellent, and oft reposted, post on here by frisco regarding the pyloric valve.  Your friend should be eating only dense proteins at this point - Chicken, turkey, fish.  These dense foods will take longer for her stomach to process and let her feel full longer.  They will also provide what she needs most - PROTEIN.  Vitamins and minerals should be coming from her supplements and not from diet right now.

If she is restricting calories to 600-800 and eating as much protein as she can, she should not have a lot of room left for carbs right now.  She should definitely NOT be indulging in sugary treats.  That will completely forestall getting her body into the proper state of ketosis where she is breaking down fat for energy instead of drawing on simple sugars or complex carbohydrates from her diet for energy.  She needs to focus on keeping her body in that Fat burning zone.

 

 Thanks. Will ask what she is eating and pass on your comments.

This is not dumping, it's reactive hypoglycemia!

She needs to go to high protein foods, and reduce the carbs and sugars in her diet.

I've had some occurrences of reactive hypoglycemia, and it's no fun.  All I wanted to do was curl up and die.  Since I'm retired, I would lay down, and the episode would pass within an hour or two.

Give her a hug, and tell her that eating anything high in carbs or sugar will trigger this condition.

HTH, Fred

At a month post-op I was still on liquids and puree foods per my Dr.'s orders. First two weeks after surgery were liquids, next 2 were purees, next 2 were soft then finally regular foods after 6 weeks. This gives the stomach time to reduce the swelling from the surgery and ensure you don't damage it in it's delicate state. NO sweets were allowed whatsoever and I still, at 3 months post op, don't eat sweets of any kind. Eggs, soft cheeses, yogurt, sf pudding, soups, meat spreads (Underwood makes good ham, chicken & beef spreads that are good during the puree stage). I haven't had a single bout of dumping even with my IBS. Hope some of this helps. I started out at about 2oz per meal every 3 hours or so. As I was able to increase my amount up to 4oz I eat about every 4-5 hours now.

 Thanks. She probably is over six weeks out, I know she is following her doc's advice to the letter. And she isn't eating sweets as such, it is just that she is finding anything with natural sugars (even those in milk products like plain yogurts) is affecting her. 

Everything being passed on! Thanks.

Kate

Being hungry this early out is not unusual.  you'll see it a lot in post of patients 3-6 weeks out. it does right itself.  Some people suffer lactose intolerance after surgery she should try rice, soy or almond milks for awhile and see if that helps. Also if she cuts down what she eats to just dense proteins and as little as she can handle at one time then introduce other things,like veg over time she may get a handle on what is causing the problem, provided what is causing the problem is input and not something connected with the surgery, like a stricture or leak.  She should also see her surgeon.

Is she on a PPI? That may be the issue with the returning hunger.. and yes, she very likely could be dumping.. Faster gastric emptying can cause this, which is why RNYers can get it too.. RH happens later, when blood sugar crashes.. but if she's having this reaction w/i 15 mins or so of eating- it's dumping, if it's an hour later- suspect RH (also called late dumping) for sure.

Protein, protein protein.. very little fat until later, and slowly introduce the fat as it can cause dumping too. The more food she puts in her stomach, the faster it will empty and cause these symptoms.. she needs to eat very slowly at first. A month out- it took me 40 mins to finish an ounce and a half of soft meat.. that was a meal. 

I didn't mess with carbs at all through this process, only slowly upping them when I hit goal. I ate mostly protein, some veggies and fat.

 Yes, she is on omeprazole.

Hey Kate!  Hope all is well.

Get your friend to post over here.  At over a month post-op, she should not at all be pushing it - the staple line is healing.  It is very early for her the stomach has to mature.  Why is she eating so much sugar?  Why aren't protein shakes still a staple in her diet?  Soft solid protein like cottage cheese, greek yogurt etc.  At just over a month out - why the heck is she "overeating"?  Not to be so harsh but we have to work with what we committed to.   This trial & error thing she is doing with food should be a very slow process.  You have to slowly begin to incorporate foods into your diet.  She's had WLS, her anatomy has changed!  Again, let me apologize  I feel a wee bit passionate.

Tell your friend to keep it simple, it is a process.  If she doesn't have the support she needs then she should certainly get over here.  The VSGers on this forum are gems.

And my stomach sleeved is fantastic but  I can't do whatever I want when I want it because that will get me in the same ditch I worked so hard to get out of.

So no hunks of sugar, protein, protein, protein (especially these first few weeks - we don't have room for much else) veggies/fruits, and if their is room for carbs, they should be complex (all mankind should refrain from machine pre-digested foods(all the white stuff).  It is the same rules we had with the band, with all WLS, and society at whole should follow suit.