My Theory on Pouch Dilation - Babs, Shelly, Dr. C

[luckyme 0]

This is my theory based on the problems I've seen others have and some issues(reflux) after my most recent fill. I've been banded about a year and a half and I've noticed that my band doesn't work the same way it did before.

Even with a tighter fill, I cannot depend on stop signals anymore, and I can definately eat more that I could earlier in my banding. I do plan to make an appointment with my doctor to discuss and to request an upper GI, and possible decrease in fill.

Based on my experience, I think that when the pouch is stretched for a period of time, it becomes less able to contract and move food through the stoma. It becomes more likely to stretch with a tight fill and too large serving sizes. I used to consistenly be able to feel the very subtle peristaltic contraction and the slight "gurgle" of food going through my stoma. I lost that after my last fill (and intermittanly before). I was having non-acid reflux at night. I believe this was because my pouch wasn't contracting to squeeze the last of the food sludge and Water that gravity didn't take care of through the stoma.

I backed off to fluids for a couple of days till I got my gurgle back, then started adding in 1/2 cup servings of solids. As long as I stick to small portions, I keep my "gurgle" and NO REFLUX. Yesterday, I had a couple of larger meals and lost the gurgle and had reflux again.

What is different about this from earlier fills is that I couldn't eat more than 1/2 cup of food after earlier fills untill the fill loosened up. I expected to get back to more noticible "stop" signs after this fill, but I didn't. I just noticed that food seems to stay in my pouch longer. I do think that my pouch stretches more easily now and when it is stretched, it doesn't move food through effectively. Because I was able to eat more before this fill, I thought my band had loosened, it may be that I'd gradually stretched my pouch. I suspect that once it stretches, it will stretch more easily in the future.

Another intersting aspect to this is that my last fill was 8 months before this one. I haven't PB'd in about 5 months. I'ts not that I'm trying to PB, just one of those things that would happen about once a month after a lapse in chewing or judgement. It was about the same time that I noticed I could start eating more.

For me, it looks like I will have to stay with strictly measured portions and/or back off on the fill to prevent future problems. I'm down 120 lbs, at a normal BMI and only 10 lbs from my personal skinny goal. I don't want to risk long term problems with my band. BTW, my doc does fills without floro unless he has a problem accessing the port.

Lucky (and I plan to stay that way)

[TexasRose 0]

Lucky -

I feel as though I have lost the sensitivity that I had earlier in the banding process. I seemed to gurgle and feel stops much more before I was over-restricted in June and then had a resulting dilated pouch.

I fight to continue the loss because of hunger but I am afraid to get adjusted any tighter because I do not want to be too tight again. I also have not PB'd in quite a while which makes me suspicious - especially when I feel that I have taken too much in at one sitting.

I am very interested in what others have to say about this topic.

[hulia goolia 0]

I have a question. I had my first fill about 5 weeks ago and have only lost 3 pounds. Sometimes I get "caught up". But, usually i can eat whatever. I feel like I am "dieting" to lose anything. I plan on getting another fill on monday? Wise choice?

[Macabella 0]

Hi Everyone, I was banded almost a year ago. I weened myself off of my aciphex because of the cost factor and ever since then, I have had problems keeping anything down. food seems to be getting stuck more often and when I go to sleep at night, I suffer from acid reflux symptoms. It has been very unpleasant to me. Hours after I eat, I still have trouble drinking anything. It's almost as if my pouch is not emtying properly. Has anyone else experienced anything like this? Waiting to hear back from you.

[leatha_g 4]

Lucky,

I think that is a very good description of what is actually happening. The whole process of overfill, restriction etc, seems to eventually cause atrophy in the esophageal constriction and peristalsis. Absolutely. Very good explanation.

[Alexandra 55]

I agree, Leatha. Lucky has very clearly summarized what seems to happen in long-term bandsters. The take-bottom line is that we get different signals that we're overdoing it--reflux, etc.--but they can be just as reliable a message to eat less. They're just less immediate messages.

[babsintx3 0]

Hi Lucky,

I just saw this string and I agree with you and wanted to add that at more than 3 years out, I lost the hard stop feeling at slightly less than 2 years out and I have been struggling with this since then, thus some regain as I eat more and more and the pouch has become larger and larger. I have been on liquids for almost 2 weeks now, but Saturday night went out to dinner with a friend who took me to a place where they had Soup and mushies so I could eat before we went out drinking and dancing. She did not want me to get totally trashed because of the liquid only diet I had been on, so I had some food.

I had:

3 oz of shrimp bisque

3 tablespoons of hummus with 3 tiny crackers

3 tablespoons f crab dip

I was so full since my stomach has probably shunken somewhat and I got the full signal right away. Not a distinct hard stop, just I'm really full feeling that I havent experienced in a while. It was amazing. What I realized with this experiment was that I really had to LISTEN for the signals because they are most definitely there.

I think in addition to dilation that as Leatha once said, we also have esophageal dysmotility issues and achalasia issues to deal with as well that cause reflux and also mean we are able to eat more before the stop signal happens. In my case, I believe it to be my rubber esophagus that is getting me in trouble. I am using it as a 2nd pouch. I dont have reflux and I hardly ever vomit. When I do, its not a PB but a complete throwup situation which also pushes food from my lower stomach through the band. I am kinda unique this way cause a lot of bandsters say that they cant throw up like they used to and mostly just spit up slime and the offending object. So there ya go. Too much info! LOL

The key to resolve some of these issues is to really focus on the quantities of what we are eating to make sure that we are not pouch packing and not to eat after 7:00 PM so that nothing remains in the pouch to give us trouble.

Babs in TX

334/180 ish

-150 ish

[June 0]

I agree, Leatha. Lucky has very clearly summarized what seems to happen in long-term bandsters. The take-bottom line is that we get different signals that we're overdoing it--reflux, etc.--but they can be just as reliable a message to eat less. They're just less immediate messages.

I was reading this discussion and I'm not sure what is meant by PB.

I was also banded by Dr. Abkin on June 6, 2005. I'm down 63 pds. It's been slow but steady. I don't have many problems, occasionally vomit but no reflux.

June

[Randi L 0]

June - do you mean you're down 63 pounds since your surgery?

What do you do? What's your program? That's really great!

a PB is a productive burp - when something gets stuck in your upper area, and you keep burping until it comes out - or all the extra air does.

How are you doing this??

[shellyj. 0]

thanks for all the insight! i do think you explained it very well!

i am being EVER so careful since my last fill.

its going to be interesting to see where the next year takes us.

michelle

[June 0]

Hi

Thanks for the response, now I know what a PB is!

My banding was June of 05, the 63 pds. has been over the 14 months.

I am not following a specific program, just eating much less, a little of everything, and I do Water arobics for exercise.

June

[Kayford 0]

My first fill did NOT give me much restriction and I think that is how most are. I could not eat dry meats but a lot of things went thru. I could even eat 1 slice of pizza after my first fill. I bet you will notice a big difference after your 2nd fill. I think you are pretty normal so don't stress just yet.

Kay