Questions about purpose of food stages

[twelvegates]

I underwent a VSG on 2/13/12 and have had absolutely no issues. No nausea/vomiting, no pain, no difficulty consuming water OR ANYTHING ELSE. I tried several pieces of steak tonight -- no problem.

I followed the protein shake/liquid diet rule for the first week after surgery. For the following two weeks (that's where I am now) , I'm supposed to consume mushie food in small quantities. Although I defininitely notice a restriction and stop eating, I've found I can eat whatever I wish.

So does anyone really know the exact purpose of following these stages? Is it to avoid any nausea issues? Is it to assist with greater weight loss by seriously restricting calories?
Is it to somehow influence the healing of the stomach?

I've read some answers to similar questions on the OH board, and the answers provided seem to come from more of a "scare tactic" position---"You'd better follow your plan if you want to achieve success"--- "Just keep doing it that way and you will fail" -- but with no real explanation.

So I asked my nutritionist and surgeon.

The nutritionist didn't really have a good answer other than to tell me that it was "best to take it slowly". I said "Why?" and she said "to avoid complications" I said "Which complications"" and she asked me if I were trying to be difficult. Seriously?? I'm 54 flippin' years old, not 13!

The surgeon said he didn't care if I moved forward in my stages, but to be aware of my restriction, carbs, protein, fats, etc. Makes more sense. He said I was progressing much more quickly than usual.

So what say you? Has anyone heard a reasoned basis for the food progression when there is no physical issue?

Seriously, I think I'll be able to consume a cup of food way before a year, but I can force myself to continue along the path of righteousness if there is a good reason. Is the only reason to "teach" me to take in much less food, and it takes 12 months to create this habit???

And yes, I certainly understand the purpose of the surgery -- to restrict my food intake -- and I have no intention of moving back in the direction which caused me to undergo this surgery in the first place.

[hoosiermama]

Sometimes, we are our own worst enemy. Being in control is not as important as being healthy and reaching our goals.

Just sayin'

[Deleted]

You might have had no issues BECAUSE you followed the food progression directions.

You got 85% or so of your stomach removed. LOTS of sutures, staples, etc. Big long cuts. These need to heal. If you had been so foolish as to put full-blown foods into that freshly sliced and diced environment, you would have risked very serious injury and possible reoperation to SAVE YOUR LIFE.

True story: There was a WLS patient who had a totally easy surgery. No pain, no nothing. What a wonderful new lease on life! She and her husband celebrated her discharge from the hospital by going to their favorite pancake house. She felt fine with eating...until she started puking up blood.

The idiot ruptured her freshly built stomach and nearly died several times over. The surgeon who told the story was still swearing about it years later.

[califsleevin]

I think that there is some over-conservatism in the general sleeve community that stems from the number of RNY docs getting into the sleeve business and applying their RNY protocols to their sleeve patients - there have been several on OH who have reported that their docs have been loosening up their progression restrictions after seeing their patients cheating and not suffering from it. My doc's program combines the liquids, mush/puree and soft protein phases into one overall stage for the first month and progressing to anything else after that, with the general admonition to try new foods one at a time to test for tolerance. They also noted that their patients tend to do better as they progress toward real food and away from shakes and the like. With their long term DS/sleeve experience, I take that to indicate that the sleeve structure on average is rather more robust than an RNY pouch.

I did push the envelope some, but with that experimental mindset of trying small quantities of new things. Yeah, I strained the veg/beef soup for a couple of days but then started leaving the lumps in and fork mashing them and nothing nasty happened. My wife and sister roasted a chicken (so the carcass could be souped) when I was about a week out and I did try a small amount of the dark meat from it along with my soup and mush meal and that set well, too - which provided the confidence to go ahead and have the resultant chicken noodle soup later that week. Likewise, I worked in french onion soup by trying small amounts of the crouton and cheese along with the broth (under the premise that the bread was already well soaked and expanded so wouldn't be expanding more in the stomach as some fear - no, I was not going to go gorge a stack at IHOP the first week!) and that settled well, too, so I progressively increased the more solid component of that soup. I was easily getting in my requisite protein by the 10 day checkup (typically around 90g) so the doc added some veg to my diet at that point.

There can be wide variations to what we can tolerate - my wife was much slower to progress when she had her DS several years ago, being much more restricted on even liquids then, but that's just part of our individual variations.

It mostly gets down to learning how to use your sleeve as a tool to reach your goals. At 9-10 months I can eat more than a cup of varied foods at a sitting, but not solid proteins as that's still restricted to around 3 oz. Judicious use of so-called sliders can boost that substantially - which can be a problem if those sliders are twinkies, but can be a real asset of they are nutritionally dense fruits and veg; salads, chilis, meat/veg stir-fry dishes can all be fairly voluminous in my system.

So, yes, it can be OK to judiciously test the waters of progression, watching for any gotchas and keeping focused on your long term goals, presumably of being healthier and not just being able to eat more cookies! (and you may even help some of these RNY docs progress up their learning curve!) But also don't hesitate to pull back and go back a couple steps if something doesn't set well, as there can be wide variations in what we can tolerate and when.

[mark540]

When the surgeon creates the new stomach he inserts a trocar (tube) of a certain size to give him a line to staple along. The tube used on me was fairly small, don't remember the exact size.

The operation is extremely traumatic to the surrounding tissue and there will be swelling along the staple line and the entire stomach will swell inside itself so that the actual opening for anything to pass thru the first few days is very small.

My surgeon told me not to eat anything that could not fit thru a drinking straw for the first week or two. That's why I was able to eat egg whites mashed with a fork and yogurt that was strained to remove fruit bits. But don't use a straw.

Likewise the intestines have just been manhandled along there length to measure them, cut open and stitched together in a new location and everywhere they cut and stitched is swollen in the beginning.

All of these swollen areas could be places for food to trap if a large piece gets down there too soon. As the weeks go by the suture lines heal and the swelling goes down.

If you followed the advice of the surgeon you hopefully will not have a problem. If you were to ignore his advice you run the risk of a shitload of possible problems and with all the possible problems that could happen in this surgery why invite more?

[Deleted]

I think that we tend to minimize having 80-85% of our stomach amputated when it's "only" for bariatric surgery. And I think that most of us would baby the hell out of what's left if we had had the same 80-85% removed due to stomach cancer.

Scare tactic--->you have had you stomach chopped the hell up. And you don't have much left. Don't risk doing ANYTHING that might hurt what's left, because the next step is going to be a REALLY big deal.

[twelvegates]

Thanks for the answers.

I've got a scientific mind, and did a lot or research before choosing the VSG, which best suited my lifestyle and medical needs. Since I questioned every aspect of the procedure and follow up regimen, I continue to seek the answers as I go through the process.

I understand all of the issues with stomach size and healing time, but wasn't really able to get the exact reason for food progression, other than caution.

I agree with califsleevin that the probable reason for the gradual change is conservatism, but that's just my working theory.

Thanks again.

[Deleted]

keep in mind that immediately post op is when you need scar tissue to form over the staple line. when you eat things that are not super easy to digest your stomach churns - and breaks that new tissue.

big staple line that needs to heal.

I'm a big proponent of seeing what works for you except in this area. well, and also don't think it's a good idea to carb load the week before surgery. oh, and stop smoking!

other than that - experiment!

[wanttolose]

My surgeon follows a faster progression plan going to mushies and purees already in the hospital. I asked him why this is and he said he sees fewer strictures than with patients who stay on liquids and full liquids for two weeks. I am going to listen to my body but feel that I'd rather err on the side of caution but don't want a stricture either...so I will see how it goes.

[countof3]

Amen Ms. CalCulator. I remember hearing "well, what's next is bypass". No thanks!!!! That one doesn't fit my lifestyle

Agreeing with the advice here. Baby it as long as you can, you've got all the time in the world to reintroduce real food later.

[highlyblessed]

Feb 23, 2012 12:47:10 GMT -5 @mscalculator said:

I think that we tend to minimize having 80-85% of our stomach amputated when it's "only" for bariatric surgery. And I think that most of us would baby the hell out of what's left if we had had the same 80-85% removed due to stomach cancer.

Scare tactic--->you have had you stomach chopped the hell up. And you don't have much left. Don't risk doing ANYTHING that might hurt what's left, because the next step is going to be a REALLY big deal.

Well put! Point well taken cause now I'm scared shitless! Thats a good thing.

[califsleevin]

Apr 13, 2012 3:10:48 GMT -5 wanttolose said:

My surgeon follows a faster progression plan going to mushies and purees already in the hospital. I asked him why this is and he said he sees fewer strictures than with patients who stay on liquids and full liquids for two weeks. I am going to listen to my body but feel that I'd rather err on the side of caution but don't want a stricture either...so I will see how it goes.

My doc is the same way, and this reinforces my impression that these experienced DS surgeons are a lot further up the learning curve on the care and feeding of a sleeve (since they've been doing sleeved stomachs for years or decades) than the RNY/band guys who are just getting into them.

[wanttolose]

Then again the Cirangle/Jossart team who are also very experienced and have excellent results insist on a two week liquid post op. Go figure!