Re: Uneducated post-op patient or RD?

[Guest guest]

I don't think you did anything wrong. I like to use 40/30/30 with my pts just because I have had more success with it but I do individualize to the pt. If they tend toward CHO foods then we go a little higher there, if they are not having any problems with it. So 40/30/30 is generally the bottom and 55/ etc would be the general top. I do measure their RMR as usually it has been significantly lowered after the sx and wt loss. I do always emphasize fiber.

Uneducated post-op patient or RD?

I just had my first GB patient. The lady that visited my office had the RNY in January of 2001. She was totally floored when I assessed her 7-day food log and gave her a meal plan based on exchanges. Her diet was high in fatty and starchy foods and low in fiber, frt/veg, and Ca++ (Milk). She didn't know that the pouch could expand back to its normal size if she didn't eat appropriate serving sizes. Dumping still occurs, on occasion, but the foods she had on her "dumping list" were also on her food log (fatty meats, ice cream, high sugars)? Now, I doubt my recommendations.She didn't give me the name of the Dr. that did the surgery in 2001 and she states that she was not given a recommendation to see a RD. In essence, she was just let go to fend for herself?! I can't get my mind off our meeting today. What are your thoughts on giving her the exchange diet (CHO 55%, PRO 23%, Fat 22%) and is my breakdown correct?Amy

[Guest guest]

My comment is about what you said about the pouch being able to " expand

back to its normal size. " I have never learned this to be the case. In

the RNY, if nothing happens to the staples, I believe the pouch size

only expands slightly. Our surgeon says that what allows a patient to

eat more over time is the anastamosis enlarges some and the upper

intestine also. In addition this upper intestine (near the anastamosis)

adapts to receiving less digested food such that the pt can eat more

without feeling sick.

Does this sound right?

I agree about the range of 40-55% carb, with less than or equal to 30%

fat. Protein % will vary based on what their caloric intake / needs are

and what it takes to meet their protein goal (in terms of gms/kg).

Simler MS, RD, CDE

ValleyCare Health System

>>> bevlyann@... 10/05/04 07:51AM >>>

I don't think you did anything wrong. I like to use 40/30/30 with my

pts just because I have had more success with it but I do individualize

to the pt. If they tend toward CHO foods then we go a little higher

there, if they are not having any problems with it. So 40/30/30 is

generally the bottom and 55/ etc would be the general top. I do measure

their RMR as usually it has been significantly lowered after the sx and

wt loss. I do always emphasize fiber.

Uneducated post-op patient or

RD?

I just had my first GB patient. The lady that visited my office had

the RNY in January of 2001. She was totally floored when I assessed

her 7-day food log and gave her a meal plan based on exchanges. Her

diet was high in fatty and starchy foods and low in fiber, frt/veg,

and Ca++ (Milk). She didn't know that the pouch could expand back to

its normal size if she didn't eat appropriate serving sizes. Dumping

still occurs, on occasion, but the foods she had on her " dumping

list " were also on her food log (fatty meats, ice cream, high

sugars)? Now, I doubt my recommendations.

She didn't give me the name of the Dr. that did the surgery in 2001

and she states that she was not given a recommendation to see a RD.

In essence, she was just let go to fend for herself?!

I can't get my mind off our meeting today. What are your thoughts on

giving her the exchange diet (CHO 55%, PRO 23%, Fat 22%) and is my

breakdown correct?

Amy

[Guest guest]

I know someone who has had the surgery

twice and failed both time. She continues to be morbidly obese.

Gundermann RD, CDE

Manager of Clinical Nutrition

Services

Good Samaritan Hospital

Bon Secours Charity Health System

(845) 368 - 5016

lgunderm@...

Re:

Uneducated post-op patientor RD?

I have heard that the pouch can

expand to nearly its original size. I also just heard from a home health

nurse that one of her patients just had the RYGB for the second time in fifteen

years. Anyone ever heard of that?

J. Bragg RD, LD

Anniston Nutrition Associates

AnnistonNutrAssoc@...

Uneducated post-op patient or

RD?

I just had my first GB patient. The

lady that visited my office had

the RNY in January of 2001. She was

totally floored when I assessed

her 7-day food log and gave her a meal plan

based on exchanges. Her

diet was high in fatty and starchy foods

and low in fiber, frt/veg,

and Ca++ (Milk). She didn't know that

the pouch could expand back to

its normal size if she didn't eat

appropriate serving sizes. Dumping

still occurs, on occasion, but the foods

she had on her " dumping

list " were also on her food log (fatty

meats, ice cream, high

sugars)? Now, I doubt my

recommendations.

She didn't give me the name of the Dr. that

did the surgery in 2001

and she states that she was not given a

recommendation to see a RD.

In essence, she was just let go to fend for

herself?!

I can't get my mind off our meeting

today. What are your thoughts on

giving her the exchange diet (CHO 55%, PRO

23%, Fat 22%) and is my

breakdown correct?

Amy

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