5 year post RNY patient

[Guest guest]

Hello, I could really use some help on this one.

I work in a health clinic (basic outpatient) and I saw a patient

today for an annual diabetic appointment. He's 5 years post R-N-Y +

cholecyctectomy (11/03) and he states he throws up every day and has

since his surgery. He says he spends $50 or more each day using trial

and error to find foods that will stay down, and those foods vary

from day to day. He says sometimes he will get food and know as soon

as he looks at it that he can't eat it. (Could there be some

psychological issue here?)

He told me that during his post surgery evaluation he was told by the

surgeon that his pouch ended up being too small.

He has undergone over 15 stomach stretching procedures and plans to

go back for another in the next month or so. He mentioned that the

surgeon recommended he come back to have the surgery reversed but he

doesn't feel like he's ready for another surgery and is worried about

making things worse than they already are.

He is not underweight. He has maintained the same weight (229 pounds)

for a year now. He is on meds for hypertension (Norvasc – switched

from Monopril and Diltiazem CR in Sept), gout (Allopurinol), and

asthma (Albuterol inhaler). He does not take meds for diabetes. His

blood sugar is well controlled, HgbA1C was 5.8 at last lab draw in

May. All labs in CMP were within normal limits as well. Urinalysis

was also good, however an additional urine albumin test done that

same day was high (30).

He says he doesn't take his meds like he is supposed to. I asked him

about a vitamin and he says he doesn't do that regularly either,

despite his doctor's recommendations.

Here are some things he told me about food:

- " moist " types of foods generally work best like tuna salad, ham

salad, etc.

-he can always do corn chips and salsa

-Coffee and Spicy V8 juice work

-Water never works

-Coke stays down

-Potatoes are a big no

-He can do cinnamon candy (Jolly Ranchers)

-Meat usually doesn't work unless it's really moist

Any advice on what might be going on?

Thanks.

TJ Ford

[Guest guest]

Is his thiamin level normal? that can cause vomiting. I would imagine he is also anemic and has a low B12 and folate.

June Zaragoza, RD/LD

Vista WLS Program

Waukegan, IL

5 year post RNY patient

Hello, I could really use some help on this one.

I work in a health clinic (basic outpatient) and I saw a patient

today for an annual diabetic appointment. He's 5 years post R-N-Y +

cholecyctectomy (11/03) and he states he throws up every day and has

since his surgery. He says he spends $50 or more each day using trial

and error to find foods that will stay down, and those foods vary

from day to day. He says sometimes he will get food and know as soon

as he looks at it that he can't eat it. (Could there be some

psychological issue here?)

He told me that during his post surgery evaluation he was told by the

surgeon that his pouch ended up being too small.

He has undergone over 15 stomach stretch

ing procedures and plans to

go back for another in the next month or so. He mentioned that the

surgeon recommended he come back to have the surgery reversed but he

doesn't feel like he's ready for another surgery and is worried about

making things worse than they already are.

He is not underweight. He has maintained the same weight (229 pounds)

for a year now. He is on meds for hypertension (Norvasc – switched

from Monopril and Diltiazem CR in Sept), gout (Allopurinol), and

asthma (Albuterol inhaler). He does not take meds for diabetes. His

blood sugar is well controlled, HgbA1C was 5.8 at last lab draw in

May. All labs in CMP were within normal limits as well. Urinalysis

was also good, however an additional urine albumin test done that

same day was high (30).

He says he doesn't take his meds like he is supposed to. I asked him

about a vitamin and he says he doesn't do that regularly either,

despite his doctor's recommendations.

Here are some things he told me about food:

-"moist" types of foods generally work best like tuna salad, ham

salad, etc.

-he can always do corn chips and salsa

-Coffee and Spicy V8 juice work

-Water never works

-Coke stays down

-Potatoes are a big no

-He can do cinnamon candy (Jolly Ranchers)

-Meat usually doesn't work unless it's really moist

Any advice on what might be going on?

Thanks.

TJ Ford

Get a free MP3 every day with the Spinner.com Toolbar. Get it Now.