Question:
I am concerned that I have stretched my pouch or outlet--how easy is it to do that?
I am 8 months post RNY. I was only 100 pounds overweight at the time of my surgery and have lost 81 of it with 19 more to go but here is my issue....I am losing very, very slowly now which my doc says is normal especially the closer to your goal weight that you become. I can accept that without a problem but I am concerned because in the first 3-4 months post-op it seems like I could only eat like half of what I eat now before I am satisfied. I am very concerned that because the volume of food I eat now is so much more than it was in the beginning that I have somehow stretched the outlet or the pouch itself. It also seems like the feeling of satiety is not as pronounced as it used to be and that I can eat much faster and can even guzzle water and swallow 3-4 pills at a time which is a big change from the first few months post-op. I am looking so good but am so afraid that once the honeymoon period is over and the functionality of malabsorption is drastically reduced that eating the volume I eat now will cause me to regain the weight. I know that I tend to be a worry wart and my nut says that most people do not understand just how hard it is to actually stretch out a pouch or stoma but I am still so concerned that I am not normal. People are always talking on this site about eating up to 1 cup or 8 oz of food at a time. I have never really weighed or measured anything. I eyeball my portions and just try to make smart choices and eat until I fell satisfied but not stuffed to the gills. I think that I can eat way more than a cup of food. I can eat a whole large dinner plate of greens and a chicken breast or a 7 oz filet and a few bited of potato and a dinner salad and be happy, satisfied and comfortable. This morning I ate a cup and a half of bran flakes with a cup and a half of 1/2% milk. Just as an example, I have eaten two tacos or two pieces of pizza or most of a 6" subway sandwich in the past as well. Just using these as volume examples---I do not eat those things as a rule! Any feedback would be so much appreciated. I need to know that I am ok and have not ruined my precious pouch. — ChelleBelle (posted on August 19, 2008)
August 18, 2008
I'm so glad that you sent this. I have been feeling the same way. I'm 8
months post op and down 81 lbs too! In the last few weeks I've noticed that
I'm not losing very much at all and that I can eat alittle more. I'm having
days where I feel hungry all day and am having to FIGHT hunger. I wish I
had an answer for you, but wanted to let you know that I am feeling the
same way and you're not alone. I was thinking of doing that 5 day pouch
test to see if that helps me or not. Have you read about that or tried it
yet? I don't know what else to do. Hang in there. Maybe someone will
respond today and help us both.
— MandyR
August 18, 2008
I am right with you. I am 3 months post op and I am afraid too. Recently I
have been able to eat more and it freaks me out too. going forward I am
going to limit my portion sizes to avoid this from happening. It scares me
because I still have about 70 pounds to lose to get to my goal weight. I
ate a sandwich yesterday with some cottage cheese and I am freaked out.
— tayee24
August 18, 2008
It is hard to stretch the pouch. If you want to test what it holds, the
first thing in the morning, not one hour after you are up but the first
thing, fix 1/2 cup of scrambled eggs, and 1/4 cup. Use a baking b\cup so
you are sure of the mesurement. Then eat the 1/2 cup, qand if you are not
full eat the 1/4 cup. when you feel ful or can not eat any more that is
your real limit as the eggs will not slide through the pouch. Make sure
you do not drink before or during this test and of course at least 1/2 hour
afterward. If you do not finish the 1/2 cup measure the eggs left over and
subtract the oz from the 4 oz in the 1/2 cup for your capacaty. Every
doctor does the pouch differently. I asked for mine to be as small as
possible so I have a limit of 3-1/2 oz.
Also have you tried the 5 day Pouch Test to give you that feeling you had
when you first had surgery? Hee is how it works and what to do.
5-day Pouch Test I beleive was developed by a WLS patient by the name Kate
Bailey and used to determine if her pouch was working and go back to that
tight newbie feeling we all had right after surgery. As a bonus to this
plan, it helps one get back to the basics of the weight loss surgery diet
and it triggers weight loss. Also, it is not difficult to follow and if you
are in a stage of carb-cycling it will break this pattern. Sounds pretty
good, right? Here we go!
Days One & Two: Liquid Protein
The first two days are all liquids. You can have as many low-carb protein
shakes as you like to satisfy hunger or cravings. In addition drink at
least six 8-ounce glasses of water each day. The purpose of all liquids is
to break any snacking, grazing or processed carbohydrate habits. In
addition the liquids will work to cleanse your system and prepare you for
the following three days. Try to reduce your caffeine intake as well, but
do not stop caffeine cold turkey or you will feel sick and frustrated
potentially losing the desire to continue with the pouch test.
If you notice symptoms of carbohydrate withdrawal you can eat a small piece
of melon or an orange. You can also try a dose of Emergen-C which should
reduce headache, dizziness or cramping from carbohydrate withdrawal.
The next three days you get to eat as much as you want as often as you
want! Ahhh, but there's a catch: it has to be solid protein and you only
get 15 minutes each time you sit down to eat.
Day 3: Soft Protein
Protein Recommendations: canned fish (tuna or salmon) mixed with lemon and
seasoned with salt and pepper, eggs cooked as desired seasoned with salt
pepper and/or salsa, fresh soft fish (tilapia, sole, orange roughy), baked
or grilled, and lightly seasoned. This starts your program with
"soft" protein. Measure your portion (1 cup volume or 4-6 ounces
weight) and eat only until you feel full, not overfull. Remember, no water
for 30 minutes before or after you meal, and no fluids with your meal. We
are going back to the beginning and fluids will prevent you from feeling
the pouch. If you need to add a bit of Miracle Whip or mayonnaise to the
canned fish I understand, but keep it to a minimum so the meat is not too
moist. One reason we lose the sense of tightness in our pouch is that we
eat "slider foods" - foods that are too moist and do not stay in
the pouch very long, they slide right through the stomach.
Day 4: Firm Protein
Protein Recommendations: ground meat (beef, turkey, lamb) cooked dry and
lightly seasoned, shellfish, scallops, lobster steamed and seasoned only
with lemon, salmon or halibut steaks, grilled and lightly seasoned. By now
you should be experiencing that familiar tightness that will reassure you
that your pouch is working. Remember to drink plenty of water between
meals. Take some time to meditate and rediscover the wonder of your pouch.
Often we do not like that uncomfortable tightness of the pouch, which is
why we gradually move toward slider foods that don't make us uncomfortable.
It is always my preference to eat moist protein so I do not get
uncomfortable, but this allows me to consume more than I should.
Rediscovering the pouch with this 5-day plan reminds us of how the tool
really works. Hope by now you are rediscovering your tool and enjoying the
hope and excitement because your pouch still works.
A word about constipation: A shift to high protein diet often results in
constipation. To relieve this you may try adding a fibrous fruit snack to
your morning and a fibrous vegetable snack in the afternoon. Fruit
suggestions are apples, berries, apricots, cantaloupe or oranges. For
vegetables try leafy greens, zucchini, cucumbers, spinach, summer squash or
string beans.
Day 5: Solid Protein
Protein Recommendations: white meat poultry cooked dry and lightly
seasoned, beef steak (if tolerated) grilled or broiled. Remember to chew
chew chew. Measure your portion (4-6 ounces) and eat only until you feel
your pouch tighten. Remember, only 15 minutes per meal, so you will have to
work fast to chew your food completely. By now you should be out of any
carb cycle you were in and perhaps you have lost a pound or two. You will
have new confidence in your pouch and your ability to work the tool for
your health and emotional well being.
— William (Bill) wmil
August 19, 2008
HI I'm a pre-op and cant talk about volume yet. But My Nurtitionist did
cover this. She said the sweeling goes away from surgery and you are able
to increase your volume.
I think measuring your portions are important. How can you know your
protein and caloric intake if you dont. Sparkpeople has a area you can
track you foods.
Goodluck
— urbrat2
August 19, 2008
It's very hard to stretch your pouch...however, there are ways to gain
weight without stretching your pouch. Grazing is one way...Grazing on
unhealthy, processed, sugary, white flour, carbs is another way. It's not
so much about how much you can eat in one sitting as much as what you are
eating in one sitting or all day long. One extra large slice of pizza,
heavy on the cheese is about 800 calories!!!!! It has about 40 grams of fat
(most of which is saturated...bad!) and 73 bad carbs...But it also has a
good 44 grams of protein...Add the greasy meats like sausage or pepperoni
and you can bring that calorie count to over 1000. No joke! Take a lean 8
ounce roasted breast of chicken without skin and you've got the same 44
grams of protein, no carbs, only 6 grams of fat, for 240 calories...Most of
us cannot even eat an entire 8 oz chicken breast. I eat half of that and
add some asparagus sauteed in a spritz of olive oil and sprinkle with some
parm cheese...add a side salad with garden veggies and a light dressing and
you've got a GREAT lean meal no where near the horrible stats of a large
slice of pizza...You want that pizza flavor...put a little sauce on the
chicken breast and melt some mozz cheese on top...It adds a little calories
and fat, but nothing like that pizza. After the weight loss stops, it's
all about the quality and leanness of your food and the choices you make.
Make your own thin crust individual pizzas on low carb wraps. They are
awesome...(Hint: toast the wrap til crispy in the oven first ...then add
toppings or else it will be too soggy) I can eat a 6 inch sub at Subway
too...But I only do that once in a while because I only eat grains and
breads three or four times a week in moderation. I like my daily carb
totals to be equal to or less than my protein intake...(It doesn't always
work out that way...but mostly it does) That's about 100 g of each...25-40g
fats total and 25-40 g fiber...We absorb calories with no trouble...So even
if we don't absorb fat and nutrients as well...our bodies find a way to
absorb the calories instead...to compensate...That is how someone can be
malnourished (vit deficient) and gain weight too! I suggest you start a
food journal and figure out the stats and calories and begin measuring out
servings and try to eat 4-5 ounces of protein and 2-3 ounces of veggies and
occasionally a 1/4 cup (1 oz) rice or potatoes. See how well you feel. It
might surprise you how much you actually DON'T need to feel good and
satisfied.
Whatever you do, DON'T begin eating more than you do now. make better
morning choices too...You are eating carbs for breakfast...for 330 calories
and only 5 g of protein (not including the milk) and 66 g of carbs! (you
can subtract the nice 14 g of fiber from 66 gs of carbs) That makes 52
carbs...(Your breakfast is half my daily max for carbs) Add that milk and
you have quite a loaded breakfast that could be sooooo much leaner...1/2 C
cereal with a boiled egg or scrambled egg beaters and a small fruit (apple
slices with peanut butter) or plain yogurt with NSA preserves...Choices
make the HUGEST difference in a cup of food...Think about it...I can eat
too! But I keep my calories low and my exercise steady and I maintain my
weight now 4.5+ years...You can do this and even have that huge slice of
pizza once in a while...I do (That's how I found out how many cals a giant
slice of Costco pizza has!) By journaling your food intake you willlearn
more about yourself and where you can cut back on wasted calories or eat
leaner etc. Here's a great free site...Even if you just want to see how
may calories are in a certain food or signature restaurant meal (Talk
about shocking!!!! Now I KNOW why I was so big!) I hope that helps...The
more you learn the more confidence you have in your pouch and yourself.
It's work...but it's easier than you think...Now you just have to talk to
your head and make certain it takes orders from your pouch...Good luck...
— .Anita R.
August 19, 2008
I can only respond to this by my own experience. I am 8 months out too. I
can eat a little more than in the first few months. But total at one meal,
does not exceed more than around a cup. That is eyeballing too. I have
never fixed my food on a regular sized dinner plate since surgery. I use a
8" plate for myself. I have had cereal, but not often, and that was
around a half cup, just moistened with milk. I find that a boiled egg
fills me up for bfst. Make the right choices. Take care of your pouch!
Good luck to ya!
— lesleigh07
August 19, 2008
I saw my surgeon today; I am about 6 1/2 months post-op. He told me for
solid foods, I should eat a max of 4 ounces at a time. 800 calories per
day. NO breads, crackers, pasta, rice, potatoes. Avoid carbs and sugars
like the plague. Eat mostly chicken, fish, tuna, eggs, beans. Afte that,
vegetables, and to rarely eat fruit. I believe what he advised it what is
best and will lead to the best long term weight loss. I personally had an
experience 2 weeks ago where I found my appetite had greatly increased; I
felt hungry constantly and could not figure out why this suddenly was
happening......... with the help of members here, I realized it was because
I had made a few bad food choices and was eating too many carbs and too
much salt. I had eaten a frozen dinner with mashed potatoes and gravy;
loaded with salt and carbs!!!!!!! Also, crackers. I swear; as soon as I cut
out the carbs and salt and went back to mainly proteins like tuna and
low-fat cheeses and beans with some vegetables, I immediately found my
hunger was back to a normal level. I really think you should consider
stopping eating things like subway sandwiches or potatoes and get back to
the rules as I my Doctor said (above). Try to reduce the quantity you eat
at one time, and be careful not to drink before, during or too soon after
meals. Faithfully take your vitamins and proteins. You may wish to see a
Nutritionist or make an appointment with your surgeon. Best wishes to you,
— Gina S.
August 21, 2008
First...congratulations on your 81 pound weight loss!! Fantastic !!
Second, I think it might help to lay off the carbs. You said it in your
last three words...."my precious pouch"....now imagine "two
pieces of pizza" (all doughed up in there) or "most of a 6"
subway sandwich" (all doughed up in there) Yes, it is precious.
So remember how you treated it when you first had your pouch and go back to
that. You can do it...you alread did! Just do it again! Best of luck to
you as you get your next 20 off!!
— snowlover
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