a few questions if anyone can help!

[Guest guest]

1. I often have patients who advance to solids too soon while they

should be on pureed foods for another week or two. I explain the

rationale for sticking to the plan but they always say they are

feeling great and the food goes down fine. Any good suggestions on

how to get them to back up to pureed/soft foods after already

experimenting successfully with solids? They say " why do I have to

blend everything if I just chew it really well? "

2. What are safe exercises besides walking, stationary bike, etc?

Can they do light weights for the arms after about 4 weeks? What

about eliptical or cross training machines? Swimming?

3. What do you tell pts who ask questions like " can I ever have

pizza again? " They want yes or no answers to specific foods.

4. Is popcorn discouraged even when they are a few months out?

5. What about orange juice that is diluted with water, 1/4 juice,

3/4 water?

thanks for your help..

[Guest guest]

1. I am not sure that you need them to go back to pureed....ask yourself what evidence there is? Just surgeons plan? If they have tried stuff and tolerated it I just let it go, we talk about what may cause problems and what to be careful with but I think there are more important things than getting them back to pureed if they are tolerating more solid foods.

2. Our weight limit restrictions are 20# so any activity that does not include lifting is fine..bike, walking, light arm stuff is all probably fine. Our MD says no soaking in water (i.e. swimming) until 1 month f/u.

3. I tell people that likely they will eventually be able to eat all foods again because that is usually the case. Most people who are 2+ years out from bypass eat most foods without difficulty, maybe only small amounts of certain things. I think we need to keep our patients from feeling anxious about food or deprived from food as those feelings are likely to lead to overeating, binge eating, feeling as though they are on a diet that eventually has an end. I try to make it a goal that they eat as normally as possible, keeping the focus on needed nutrients first.

4. Popcorn has been tolerated quite well by many of my patients, not something I per se encourage but may be quite well tolerated even at 3-4 months post-op.

5. Juice we suggest diluted half and half but I know many drink it straight without problem.

My 2 cents

Laschkewitsch RD

[Laschkwitsch, :LPH Obes Inst] -----Original Message-----From: [mailto: ]On Behalf Of brigittebibeauSent: Tuesday, October 17, 2006 11:33 AM Subject: a few questions if anyone can help!

1. I often have patients who advance to solids too soon while they should be on pureed foods for another week or two. I explain the rationale for sticking to the plan but they always say they are feeling great and the food goes down fine. Any good suggestions on how to get them to back up to pureed/soft foods after already experimenting successfully with solids? They say "why do I have to blend everything if I just chew it really well?"2. What are safe exercises besides walking, stationary bike, etc? Can they do light weights for the arms after about 4 weeks? What about eliptical or cross training machines? Swimming?3. What do you tell pts who ask questions like "can I ever have pizza again?" They want yes or no answers to specific foods.4. Is popcorn discouraged even when they are a few months out? 5. What about orange juice that is diluted with water, 1/4 juice, 3/4 water?thanks for your help..

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

[Guest guest]

We recommend holding off on popcorn til 6 months and after that it's their choice - we just remind them to chew well and eat slowly. Right now I have a 6 month postop patient who can tolerate 64 ounces OJ daily - non diluted! (not recommended by the way). We tell our patients that everyone is different as far as tolerance to various foods 1+ year postop....there are no yes/no answers...they usually experiment anyway.

SR , RD (608) 260-6524

From: [mailto: ] On Behalf Of Laschkwitsch, :LPH Obes InstSent: Tuesday, October 17, 2006 3:18 PM Subject: RE: a few questions if anyone can help!

1. I am not sure that you need them to go back to pureed....ask yourself what evidence there is? Just surgeons plan? If they have tried stuff and tolerated it I just let it go, we talk about what may cause problems and what to be careful with but I think there are more important things than getting them back to pureed if they are tolerating more solid foods.

2. Our weight limit restrictions are 20# so any activity that does not include lifting is fine..bike, walking, light arm stuff is all probably fine. Our MD says no soaking in water (i.e. swimming) until 1 month f/u.

3. I tell people that likely they will eventually be able to eat all foods again because that is usually the case. Most people who are 2+ years out from bypass eat most foods without difficulty, maybe only small amounts of certain things. I think we need to keep our patients from feeling anxious about food or deprived from food as those feelings are likely to lead to overeating, binge eating, feeling as though they are on a diet that eventually has an end. I try to make it a goal that they eat as normally as possible, keeping the focus on needed nutrients first.

4. Popcorn has been tolerated quite well by many of my patients, not something I per se encourage but may be quite well tolerated even at 3-4 months post-op.

5. Juice we suggest diluted half and half but I know many drink it straight without problem.

My 2 cents

Laschkewitsch RD

[Laschkwitsch, :LPH Obes Inst] -----Original Message-----From: [mailto: ]On Behalf Of brigittebibeauSent: Tuesday, October 17, 2006 11:33 AM Subject: a few questions if anyone can help!

1. I often have patients who advance to solids too soon while they should be on pureed foods for another week or two. I explain the rationale for sticking to the plan but they always say they are feeling great and the food goes down fine. Any good suggestions on how to get them to back up to pureed/soft foods after already experimenting successfully with solids? They say "why do I have to blend everything if I just chew it really well?"2. What are safe exercises besides walking, stationary bike, etc? Can they do light weights for the arms after about 4 weeks? What about eliptical or cross training machines? Swimming?3. What do you tell pts who ask questions like "can I ever have pizza again?" They want yes or no answers to specific foods.4. Is popcorn discouraged even when they are a few months out? 5. What about orange juice that is diluted with water, 1/4 juice, 3/4 water?thanks for your help..

IMPORTANT NOTICE: This communication, including any attachment, contains information that may be confidential or privileged, and is intended solely for the entity or individual to whom it is addressed. If you are not the intended recipient, you should contact the sender and delete the message. Any unauthorized disclosure, copying, or distribution of this message is strictly prohibited. Nothing in this email, including any attachment, is intended to be a legally binding signature.

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