Re: Re: no restriction with optimal fill

[Guest guest]

She is alternating liquids and solids, waiting 30 minutes before drinking, and no carbonation..

I do agree that patients may not recognize the restricition.

Thanks everyone!!!

Re: no restriction with optimal fill

Hello,I hate to ask this, but is the patient drinking any liquids while eating solids? Does she wait 30-60 minutes after eating before starting liquids again? Is she slipping in any carbonated beverages? Parrott, MS,RD,LD>> I have a patient who despite 7 ml in her band denies a feeling of restriction. UGI shows a small stoma (surprised she does not vomit with this). Per her food diary, she is eating appropriate foods....She is challenging her band by eating meats, fruits, vegies, etc. No evidence of slider foods or soft textured foods. The surgeon told her to stop chewing foods so well so she feels

restriction. . This has been in the back of my mind...we tell patients to chew to a liquid consistency before they swallow..Is a surprise they feel restriciton with this?> She has met with the psychologist as well.> Any advise?> Beth Taschuk RD>

[Guest guest]

Hi :

Sorry for the lack of clarity..What I mean by alternating liquids and solids is that they are instructed not to eat and drink with their meals and for 30-60 minutes after their meals...

Yes, I learned in practice to teach patients to "challenge your band" meaning to eat textured foods as oppossed to slider foods. However we have always taugh patients to chew their foods very well to ensure passage through the stoma..

As you said not so much chewing that it defeats the design of the band and slides right through..... The patient needs to listen to their band and find what works for them.

Thanks for the discussion,

Beth

Re: no restriction with optimal fill

I don't understand.. .why is the patient alternating liquids and solids? What seems to create satiety for most patients is to eat only tid with no grazing. If they are not able to eat their meals spaced no more than 4-5 hours apart, they should eat a protein snack or sip on a protein supplement in between the meals. Patients are encouraged to sip on non-carbonated fluids throughout the day even up until the time they eat. The critical time not to drink fluids is during the meal and 30-60 minutes after eating. Picture a blender or a small funnel...we don't want the patient to liquify what they have worked so hard to get into their pouch, thus sending the chewed mush straight through the pouch into the stomach.Does this help? What is TOGA? Parrott, MS, RD, LD

[Guest guest]

We use a hunger fullness scale of 0-10 and discuss not wanting to operate out at the extreme's. This is a learning process and definitely takes practice, but I still have patients that report not knowing what satiety is they only recognize 10 or thanksgiving day full and frequently vomit.

From: julie.parrott <julie.parrott@...>Subject: Re: no restriction with optimal fill Date: Wednesday, October 22, 2008, 6:13 PM

It's interesting. ..there are a lot of LAGB and bariatric pts who do have difficulty with satiety. I found a tool that might help LAGB pts determine when they are physically hungry and when they reach satiety..Have you discussed the feeling of fullness with the band? not that same bloated stuffed feeling prior to LAGB?you defintiely have me curious....

[Guest guest]

I notice that some of you discourage carbonated beverages and I am aware that often cause discomfort after bariatric surgery, but is there any research to support the common myth that they stretch the stoma or any other reason why I should be discouraging them with bariatric pts (other than artifical sweetner quandry?)

thanks,

On Wed, Oct 22, 2008 at 5:21 PM, Beth Taschuk <bethhanne@...> wrote:

Hi :

Sorry for the lack of clarity..What I mean by alternating liquids and solids is that they are instructed not to eat and drink with their meals and for 30-60 minutes after their meals...

Yes, I learned in practice to teach patients to " challenge your band " meaning to eat textured foods as oppossed to slider foods. However we have always taugh patients to chew their foods very well to ensure passage through the stoma..

As you said not so much chewing that it defeats the design of the band and slides right through..... The patient needs to listen to their band and find what works for them.

Thanks for the discussion,

Beth

Re: no restriction with optimal fill

I don't understand.. .why is the patient alternating liquids and solids? What seems to create satiety for most patients is to eat only tid with no grazing. If they are not able to eat their meals spaced no

more than 4-5 hours apart, they should eat a protein snack or sip on a protein supplement in between the meals. Patients are encouraged to sip on non-carbonated fluids throughout the day even up until the time they eat. The critical time not to

drink fluids is during the meal and 30-60 minutes after eating. Picture a blender or a small funnel...we don't want the patient to liquify what they have worked so hard to get into their pouch, thus sending the chewed mush straight through the pouch into the stomach.

Does this help? What is TOGA? Parrott, MS, RD, LD

-- LeBrun, MPH,RD

Senior Nutritionist Washington Medical Faculty Associates2150 Pennsylvania Ave., NWSte 6-105Washington, DC 20037202.741.2422clebrun@...