Pouch Stretching Information

[dandeegan 21]

Hello all,

I am trying to find out some definitive answers regarding pouch stretching. I can find answers to questions such as 'how hard is it to stretch the pouch', 'is it permanent when a pouch is stretched or can i shrink it back down', 'how do i know if my pouch is stretched' and so on, but the answers vary.

I was banded a little over two years ago now and my weight loss stopped at roughly 60lbs. I haven't really lost any in a while and I actually gained some back after a bit after hitting the 70lb mark. 60lbs is a decent amount and I worked my butt off for it, but I am a pretty big guy and could stand to lose another 100 haha. Like many people on here I feel like I've lost touch with the band, or feel like it doesn't really work anymore and I often wonder if my pouch is stretched, or I have slippage or something. Hopefully it's just paranoia.

When I try to read up on pouch stretching, some people/sites say that it happens if you overeat. Other sites say that you can't really stretch the pouch because it's in an inelastic part of the stomach that doesn't really stretch, and you'll vomit if you eat that much well before you can stretch the pouch. Some say once it's stretched your screwed. Others say that it shrinks back down. Well, which is it? I got my band at University of Pennsylvania that has a huge bariatric division with bigwig surgeons and zillions of dollars in resources. Even they say that it is extremely difficult to stretch the pouch.

The bottom line of this post is that lately I've really been wanting to get back into lap-band culture (for lack of a better term). It pretty much feels like it's not even there anymore, and I'd really like to start using it again if I can. I'm trying to get affirmation that it's not too late, my pouch and band are ok and I can start over. Unfortunately, I am without health insurance and in a financial situation where I'd need to decide between making my car payment or going to UPenn for a checkup. I don't even want to know what an upper GI would cost out of pocket. I'd probably get evicted if I got one! So I hope to get some insight from you guys on this in the meantime

[Dave_NW 92]

Hello all,

I am trying to find out some definitive answers regarding pouch stretching.

The bottom line of this post is that lately I've really been wanting to get back into lap-band culture (for lack of a better term).

Hi Dandeegan,

I can easily appreciate your desire to get back into things, and hope I can offer some ideas.

First things first: Read up on, and then do the "Five Day Pouch Test." It will basically test your pouch, and give you a solid baseline to start from. By the end of it, you'll know if your pouch is working right. If your pouch IS stretched, all it means is that you have a larger pouch than you used to have. Regardless of whether it goes back to its correct size, as I see it, if you use Portion Control to regulate how much you're eating, you can still eat a bandster-sized meal. And if you don't eat more than you know you should, things should take care of themselves. Here is the text of a recent LBT thread about the Five Day Pouch Test:

*********************************

Day 1 & 2-The first two days are all liquids. You can have as many low-carb Protein shakes as you like to satisfy hunger or cravings. In addition drink at least six 8-ounce glasses of Water each day. The purpose of all liquids is to break any snacking, grazing or processed carbohydrate habits. In addition the liquids will work to cleanse your system and prepare you for the following three days. Try to reduce your caffeine intake as well, but do not stop caffeine cold turkey or you will feel sick and frustrated potentially losing the desire to continue with the pouch test. It is very important to drink a minimum of 64 ounces of Water each day. This will prevent dehydration, will help curb cravings and will flush your body of toxins and fat. Sufficient water intake improves kidney function and cell processes.

Day 3: Soft proteins- The next three days you get to eat as much as you want as often as you want! But there's a catch: it has to be solid Protein and you only get 15 minutes each time you sit down to eat. No drinking 30 minutes before or after meals and no drinking with your food. A dry pouch will hold your soft protein longer helping you to feel full and fed longer. Protein Recommendations: canned fish ( tuna or salmon) mixed with lemon and seasoned with salt and pepper, eggs cooked as desired seasoned with salt pepper and/or salsa, fresh soft fish (tilapia, sole, orange roughy), baked or grilled, and lightly seasoned. This starts your program with "soft" protein. Measure your portion (1 cup volume or 4-6 ounces weight) and eat only until you feel full, not overfull. Remember, no water for 30 minutes before or after your meal, and no fluids with your meal. We are going back to the beginning and fluids will prevent you from feeling the pouch. If you need to add a moist condiment (Miracle Whip or mayonnaise) to the canned fish I understand, but keep it to a minimum so the meat is not too moist. One reason we lose the sense of tightness in our pouch is that we eat "slider foods" -foods that are too moist and do not stay in the pouch very long, they slide right through the stoma. Cottage cheese is a good protein and you can include it on Day 3. To firm it up a bit you could add a chopped hard cooked egg to your cottage cheese. And yes, during the liquid phase chicken boullion with added protein is great.

Day 4 Firm Protein- Protein Recommendations: ground meat (beef, turkey, lamb) cooked dry and lightly seasoned, shellfish, scallops, lobster steamed and seasoned only with lemon, salmon or halibut steaks, grilled and lightly seasoned. By now you should be experiencing that familiar tightness that will reassure you that your pouch is working. Remember to drink plenty of water between meals. Take some time to meditate and rediscover the wonder of your pouch. Often we don't like that uncomfortable tightness of the pouch, which is why we gradually move toward slider foods that don't make us uncomfortable. It is always my preference to eat moist protein so I don't get uncomfortable, but doing so allows me to consume more than I should. Rediscovering the pouch with this 5-day plan reminds me of how the tool really works. I hope by now you are rediscovering your tool and enjoying the hope and excitement because your pouch still works.

Day 5 Solid Protein- Remember to chew chew chew. Measure your portion (4-6 ounces) and eat only until you feel your pouch tighten. Remember, only 15 minutes per meal, so you'll have to work fast to chew your food completely. By now you should be out of any carb cycle you were in and perhaps you have lost a pound or two. You will have new confidence in your pouch and your ability to work the tool for your health and emotional well being. Don't go hungry! Remember, you can eat as often as you want as long as it is solid protein, consumed without liquids and measured in 4-6 ounce portions.

*********************************

After you've determined whether your pouch is working right, and you have your food portions back to the correct bandster-size meals, the next thing to consider is WHAT you're eating. If your weight loss is stalled, then you need to figure out why. Are you tracking HONEST calories every day? Are you eating junk food, slider foods, empty calories, or snack foods, instead of "real" food? I follow a modified South Beach Diet kind of thing - higher protein, lower glycemic carbs, and avoiding fried food, fats, and sugary foods. For me, it's all about moderation, and trying to get roughly 10% of my daily calories from protein. So if I'm eating 1200 calories a day, I try to get 120 of those calories from protein. I try to make sure I eat more protein grams than carb grams in a day, to keep my diet balanced. Every time I put something in my mouth I make sure I'm eating because it's right for me, and not just out of habit.

And probably the most important thing you need to figure out is how many calories a day you're burning off. If you're not burning more than you take in, you won't lose weight. It's that simple. You have to get out of your chair and move. Even a little at a time helps, but the more you can do, the better your weight loss will be.

You have to take charge of your band, and work it like the tool that it is. Are you working out regularly, are you trying to stay as active as possible, and are you proactive in your band's performance? Or are you someone who expects the band to do all the work? If you balance eating right with proper exercise, drinking enough water every day, and getting enough sleep every night, you WILL lose weight.

Hope this helps, and gives you some ideas of things to try. Good luck!

Dave

[cheryl2586 3,053]

Although everyone wants to give their opinions I do believe you should ask your doctor that question. Its not a matter for us to tell you if it is or isnt. I would have the doctor go over this with you because anything that has to do with stretching, erosion, or slippage should be discussed with your doctor then he can figure out if your having issues.

[Humming Bird 275]

When was your last fill? It may be something as simple as getting a small fill to get things going again for you.

[dandeegan 21]

Although everyone wants to give their opinions I do believe you should ask your doctor that question. Its not a matter for us to tell you if it is or isnt. I would have the doctor go over this with you because anything that has to do with stretching, erosion, or slippage should be discussed with your doctor then he can figure out if your having issues.

This is indeed true. I wasn't looking for you guys to tell me if my band is stretched, I'm more or less looking to see if anyone knows what the real (or at least most commonly known) answer is in regards to stretching. Does it or does it not? Does it shrink back or doesn't it? Things like that.

Thanks Dave, that information is great. I did see the 5 day test and am looking into doing it. Already have it printed out You lost 120lbs in less than a year? That's extraordinary.

[dandeegan 21]

When was your last fill? It may be something as simple as getting a small fill to get things going again for you.

My last fill was sometime in April, 2010. Right before I lost my health insurance. I have food get stuck pretty often, actually. Sometimes it even leads to the ol' finger down the throat to make me heave it out.

[Dave_NW 92]

Thanks Dave, that information is great. I did see the 5 day test and am looking into doing it. Already have it printed out You lost 120lbs in less than a year? That's extraordinary.

Glad to be able to offer you some ideas. Not having insurance must make your journey a tough one. Good luck with whatever you decide.

Yes, those weight loss numbers are correct. I had surgery December 6, 2010, and I actually hit 120 pounds lost about a month ago. I've been on vacation and such during the last month, so set aside my weight loss routine, and have just gotten back to the gym this past week. I manage the heck out of my band, and I'm in the gym four or five days a week. I have 9.2cc in a 14cc band, and I have great restriction. I've had zero problems with my band, and excellent results. My fill PA jokes that if there was a poster boy for this process, I'd be that guy.

Dave

[Rachel412 116]

Honestly, I don't give much credit to any thought of "pouch stretching" when it comes to us banded people. Medical studies have shown that whatever we eat passes very quickly through our stomas. It's not like people originally thought, that the food just sat in our "pouches" above the band and once that "pouch" is full, then we feel full, and the food then trickles slowly through the band. So while you can surely have your band slip and this makes your "pouch" "stretch"- i.e. there's more of your stomach above the band than there used to be- we don't have a small pouch like is created by some of the other weight loss surgeries.

I believe the 5 day pouch test works for us because it's just restricting what we eat and getting us used to smaller portions again, I don't truly believe that pouch stretching is an isssue for banded people.

Like I said- this is just my opinion. I am quite sure others disagree.

[Marcib 1]

Thanks Dave I'm going to try the 5 day test.

[NYMoMof3 0]

I would love to know this answer too. Im a newbie and im really struggling, I eat way more than should, say 1.5 cups instead of 1/2 cup, and Im still hungry. I even find myself grazing in between. I think Im eating to many carbs and sugar so Im going to try Daves 5 day band test..minus the solid food since im only banded 3 weeks. Someone said to me that my pouch may be to big or now stretched out from over eating. I wonder if this is true. I guess the only true test would be an extra of the stomach. My first fill is in 3 weeks, I wish I could get it now, I miss that feeling of fulness and restriction. Good luck everyone!

[B-52 7,113]

IMO I find it very hard, if not impossible to stretch your pouch.

My band is very tight, and I like it that way. Makes it very easy to manage what, and how I eat. In my case the food does sit in the pouch, and passes through the

band very slowly, depending on the type of food I am eating. I can feel it with every swallow.

I have to put the fork down between swallows and allow the food to go through. Eat to quickly, or too much, and the food accumulates and I am in pain, or stuck.

Drinking fluids while eating will only compound the issue.

Having said that, in order to stretch your pouch, you would first of all need a certain level of restriction for food to accumulate in the pouch.

When this happens, you will know it. Too much and you are in a great deal of discomfort, and perhaps pain.

To stretch your pouch, if possible, you would have to over do it from this point. I can tell you from personal experience it is not a pleasant thing to do.

The food has no where to go, but back up from where it came!! The slimeing will begin! Not to mention the pain you may experience. Someone here described it as swallowing a golfball, and having it sit there!

So, like I said, if it where possible, it would be very hard to do, IMO.

As a side note, all these little things they teach you to do: Chewing, waiting between swallows, drinking while eating, etc, etc, I have now found to happen naturally because of the level of restriction I have.

Many people will say I am too tight. But everything I was told before the surgery is now reality.

There is a way to work around and cheat the band, but I will never give anyone here any ideas, so I will never talk about it.

[transforming jlaroux 78]

I would love to know this answer too. Im a newbie and im really struggling, I eat way more than should, say 1.5 cups instead of 1/2 cup, and Im still hungry. I even find myself grazing in between. I think Im eating to many carbs and sugar so Im going to try Daves 5 day band test..minus the solid food since im only banded 3 weeks. Someone said to me that my pouch may be to big or now stretched out from over eating. I wonder if this is true. I guess the only true test would be an extra of the stomach. My first fill is in 3 weeks, I wish I could get it now, I miss that feeling of fulness and restriction. Good luck everyone!

You probably don't have a fill yet! There is little to no restriction prior to a fill. your tummy was swollen which is why you initially had restriction, now that it has gone down, you are back to pre-surgery tummy. Take this time prior to your first fill to heal, not worry about weight loss. Follow your doctor's orders, your tummy is not stretched.

[Corrigan 75]

There's also a thing called "The cottage cheese test" to check the absolute capacity

of your pouch. It sounds funny, but I guess it's been recognized scientifically.

Look it up on Google, it uses displacement of Water with cottage cheese to determine

the absolute size of your pouch, FWIW.

And I'm willing to bet the U of PA doctors know more about WLS

than any of us on this web site.

[Noturningback15 45]

I am not sure if the pouch can be stretched or how long it stays that way. I have read that your esophagus can become enlarged/damaged dueto eating too much at once, and the food sitting up there until it passes through the pouch.

Hello all,

I am trying to find out some definitive answers regarding pouch stretching. I can find answers to questions such as 'how hard is it to stretch the pouch', 'is it permanent when a pouch is stretched or can i shrink it back down', 'how do i know if my pouch is stretched' and so on, but the answers vary.

I was banded a little over two years ago now and my weight loss stopped at roughly 60lbs. I haven't really lost any in a while and I actually gained some back after a bit after hitting the 70lb mark. 60lbs is a decent amount and I worked my butt off for it, but I am a pretty big guy and could stand to lose another 100 haha. Like many people on here I feel like I've lost touch with the band, or feel like it doesn't really work anymore and I often wonder if my pouch is stretched, or I have slippage or something. Hopefully it's just paranoia.

When I try to read up on pouch stretching, some people/sites say that it happens if you overeat. Other sites say that you can't really stretch the pouch because it's in an inelastic part of the stomach that doesn't really stretch, and you'll vomit if you eat that much well before you can stretch the pouch. Some say once it's stretched your screwed. Others say that it shrinks back down. Well, which is it? I got my band at University of Pennsylvania that has a huge bariatric division with bigwig surgeons and zillions of dollars in resources. Even they say that it is extremely difficult to stretch the pouch.

The bottom line of this post is that lately I've really been wanting to get back into lap-band culture (for lack of a better term). It pretty much feels like it's not even there anymore, and I'd really like to start using it again if I can. I'm trying to get affirmation that it's not too late, my pouch and band are ok and I can start over. Unfortunately, I am without health insurance and in a financial situation where I'd need to decide between making my car payment or going to UPenn for a checkup. I don't even want to know what an upper GI would cost out of pocket. I'd probably get evicted if I got one! So I hope to get some insight from you guys on this in the meantime

[Humming Bird 275]

IMO I find it very hard, if not impossible to stretch your pouch.

My band is very tight, and I like it that way. Makes it very easy to manage what, and how I eat. In my case the food does sit in the pouch, and passes through the

band very slowly, depending on the type of food I am eating. I can feel it with every swallow.

I have to put the fork down between swallows and allow the food to go through. Eat to quickly, or too much, and the food accumulates and I am in pain, or stuck.

Drinking fluids while eating will only compound the issue.

Having said that, in order to stretch your pouch, you would first of all need a certain level of restriction for food to accumulate in the pouch.

When this happens, you will know it. Too much and you are in a great deal of discomfort, and perhaps pain.

To stretch your pouch, if possible, you would have to over do it from this point. I can tell you from personal experience it is not a pleasant thing to do.

The food has no where to go, but back up from where it came!! The slimeing will begin! Not to mention the pain you may experience. Someone here described it as swallowing a golfball, and having it sit there!

So, like I said, if it where possible, it would be very hard to do, IMO.

As a side note, all these little things they teach you to do: Chewing, waiting between swallows, drinking while eating, etc, etc, I have now found to happen naturally because of the level of restriction I have.

Many people will say I am too tight. But everything I was told before the surgery is now reality.

There is a way to work around and cheat the band, but I will never give anyone here any ideas, so I will never talk about it.

I pretty much feel this way too ... ditto

I also believe some people may not feel the pain/discomfort I feel and can use their esophagus as part of their pouch.

I think this is how the esophagus can be damaged. If I even eat one bite too much, because solid food does stay in my pouch for quite some time due to my level of restriction, it causes pain and other bad things .....