Guest guest Posted May 12, 2004 Report Share Posted May 12, 2004 Hi Randee--Always tough if you can't get the anatomical studies you would need for a complete work up -- is it possible to get her worked up with the PMD? You didn't mention bowel patterns, could be important to establish routine BM's. If she is passing gas, it rules out a complete blockage, however, there could be a partial with only a bowel build up (and hence pain) eventually pushing through the partial blockage. She really needs to have an upper gi and a gastric emptying study to look for strictures and delayed emptying. If she has a gallbladder, you would also need to consider gallstones especially if she had rapid loss without prophylactic bile salts or if she was inconsistent about taking them. You didn't mention the location of the pain and the degree and type. All of these would be helpful in pinpointing her problem.How is her weight loss? If weight loss is poor with these symptoms, you would need to also r/o a gastro-gastric fistula.Although it is easy to always point the finger at gastric bypass surgery, it doesn't negate the need to practice good medicine and rule out other organic issues. She should be worked up by a GI team. If she is one of ours, please let me know if I can help facilitate anything!JBJeanne Blankenship, MS RDBariatric Surgery Nutrition CoordinatorUC Medical CenterSacramento, CA 95817916-734-7260 " Randee Reidy " <rreidy@...>05/12/2004 08:10 PM MSTPlease respond to < > cc: bcc: Subject: Problem patient Again, thanks to everyone for their input - I learn so much from this group!!I have a new patient I just saw, 18 months postop RNY, a local surgeon. She has had constant pain since surgery with high levels of gas, both belching and flatulence. Her original surgeon ignored her. She has now gone to a 2nd surgeon, who repaired a hernia she had, and according to her (no notes from the 2nd surgeon), also repaired some " bunched intestines " . She is still not any better. She is in constant pain, especially when hungry, and is using GasX with some relief.I reviewed the standard questions, ie, drinking with meals, small bites, chewing thoroughly, not drinking with meals, etc. etc., and she seems compliant with instructions. Her original surgeon did try digestive enzymes, no help.Any input? My original thought was to get her off any food allergens and into a simple diet, so she is trying three weeks of no dairy, wheat, soy, eggs, milk or yeast. Thanks for your help.Randee Reidy, MA, RDThe Hopkins HouseSacramento, CArreidy@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 Had she been eating any of the "sugar-free" foods with the sugar alcohols? these can cause GI distress in some people. -----Original Message-----From: Randee Reidy [mailto:rreidy@...]Sent: Wednesday, May 12, 2004 10:10 PM Subject: Problem patient Again, thanks to everyone for their input - I learn so much from this group!! I have a new patient I just saw, 18 months postop RNY, a local surgeon. She has had constant pain since surgery with high levels of gas, both belching and flatulence. Her original surgeon ignored her. She has now gone to a 2nd surgeon, who repaired a hernia she had, and according to her (no notes from the 2nd surgeon), also repaired some "bunched intestines". She is still not any better. She is in constant pain, especially when hungry, and is using GasX with some relief. I reviewed the standard questions, ie, drinking with meals, small bites, chewing thoroughly, not drinking with meals, etc. etc., and she seems compliant with instructions. Her original surgeon did try digestive enzymes, no help. Any input? My original thought was to get her off any food allergens and into a simple diet, so she is trying three weeks of no dairy, wheat, soy, eggs, milk or yeast. Thanks for your help. Randee Reidy, MA, RD The Hopkins House Sacramento, CA rreidy@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 Does anyone know if sugar alcohols cause dumping syndrome in most patients? I have long term post-op people handling them fine, but don't know quite how to advise new patients. Thanks Simler, MS, RD, CDE ValleyCare Health System >>> piking@... 05/13/04 02:19PM >>> Had she been eating any of the " sugar-free " foods with the sugar alcohols? these can cause GI distress in some people. Problem patient Again, thanks to everyone for their input - I learn so much from this group!! I have a new patient I just saw, 18 months postop RNY, a local surgeon. She has had constant pain since surgery with high levels of gas, both belching and flatulence. Her original surgeon ignored her. She has now gone to a 2nd surgeon, who repaired a hernia she had, and according to her (no notes from the 2nd surgeon), also repaired some " bunched intestines " . She is still not any better. She is in constant pain, especially when hungry, and is using GasX with some relief. I reviewed the standard questions, ie, drinking with meals, small bites, chewing thoroughly, not drinking with meals, etc. etc., and she seems compliant with instructions. Her original surgeon did try digestive enzymes, no help. Any input? My original thought was to get her off any food allergens and into a simple diet, so she is trying three weeks of no dairy, wheat, soy, eggs, milk or yeast. Thanks for your help. Randee Reidy, MA, RD The Hopkins House Sacramento, CA rreidy@... <mailto:rreidy@...> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 13, 2004 Report Share Posted May 13, 2004 Thank you, sugar alcohols are a good suggestion, but I did check that. RE: Problem patient Had she been eating any of the "sugar-free" foods with the sugar alcohols? these can cause GI distress in some people. -----Original Message-----From: Randee Reidy [mailto:rreidy@...]Sent: Wednesday, May 12, 2004 10:10 PM Subject: Problem patient Again, thanks to everyone for their input - I learn so much from this group!! I have a new patient I just saw, 18 months postop RNY, a local surgeon. She has had constant pain since surgery with high levels of gas, both belching and flatulence. Her original surgeon ignored her. She has now gone to a 2nd surgeon, who repaired a hernia she had, and according to her (no notes from the 2nd surgeon), also repaired some "bunched intestines". She is still not any better. She is in constant pain, especially when hungry, and is using GasX with some relief. I reviewed the standard questions, ie, drinking with meals, small bites, chewing thoroughly, not drinking with meals, etc. etc., and she seems compliant with instructions. Her original surgeon did try digestive enzymes, no help. Any input? My original thought was to get her off any food allergens and into a simple diet, so she is trying three weeks of no dairy, wheat, soy, eggs, milk or yeast. Thanks for your help. Randee Reidy, MA, RD The Hopkins House Sacramento, CA rreidy@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 14, 2004 Report Share Posted July 14, 2004 check her for vit/min deficiencies -------------- Original message -------------- Hello,I was wondering if anyone has any suggestions for a problem patient. I have a patient who had gastric bypass surgery about two months ago. She has been re-admitted into the hospital on serveal occasions due to nausea and unable to keep anything down. She has been checked for an ulcer and stricture, but all if her tests were negative. She always feels like she has to spit. Yesterday, she was admitted to the hospital again and they're going to send her home with TPN for 2 week just to get some nutrition in her and keep her hydrated. Pysch will also be following her. Anyone else have any recommendations or see this happining?Thanks you,Marcie Amernick, RD LDN Quote Link to comment Share on other sites More sharing options...
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