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stricture problem or just food sensitivity



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I'm one month post surgery and I was wondering if I have a stricture issue or just sensitive to some food. I can throw up sometimes after eating but only once a day at most. I have acid reflex still and I'm on medication for it but feel like stuff still gets stuck like chicken. Should I just give it more time or be worried?

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Might still be early days for chicken, eat slow, small small bites, pause between bites, lay your eating utensil down, don't talk, don't get distracted, don't brood over what someone said or snide remarks, warm things work better for me. Remember you're not punching a time clock, respect your new gastric environment, it is having to learn to cope too.
I am 9 weeks out, and as I said in the previous thread I have become the DoorKeeper and bouncer at Club Stricture, a job certainly I did not interview 💦🔉for. And I argued for 3 weeks with my Bariatric Team that I DID have a stricture, and OMG the excuses I got! Varied from" You have to give things ⏰time" to " You just want attention!" Oh was the 📣stridecy in my voice a CLue? Finally,to shut ME up they scheduled an🔍 Endoscopy, an EGJ, because of course you never can visualize an bypassed duodenum by EASY MEANs. And who was right? ME ME ME! Yeah I don't have a bunch,of degree letters after my name, but I do know MY body, I have been living in ME a long time and besides I am puking almost as much as I did pregnant, and I can count on my 2 hands without going to toes, the episodes of emesis since then. I do not upchuck freely. So every 2 weeks, October 12, October 26, November 9th, I haul my Happy Hoohah to Ohio State University Hospital to the Endoscopy/Hepatology Lab for Fun and Games. The nurses are starting to recognize me, Dr Noria, the😷 bariatric surgeon who LOVES doing endoscopy greets me by name instead of #. and the surgery tech nurse says I get a Frequent Flyer card at the End of November. Asked if it has a Plumb and Fun sticker,on it? What a lovely idea THAT IS! That's me, a bundle,of fun and weird suggestions!👈👸👉💦So omeprazole twice daily, Zofran 3 times daily, Carafate every 6 hours around the clock and now a new directive, I can no longer be around active smokers or anyone with residue on their clothing. Why? Because my 3 ulcers have weakened. and are now at risk of bleeding/ perforation. Since Tomk8tten and I neither smoke or allow it inside, that's her first intervention. Lovely going up friends, associates, even people on the street, May I sniff you FIRST before we have a conversation? Barely have that many left, remember I have reached the age when peers drop like Flies!😭😝😪

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According to the guidelines I received for gastric bypass, I was on full liquids for the first 4 weeks post op, pureed foods for the next four weeks and only at week 9 could I transition to solids.

I found that many solid foods (such as chicken and steak were difficult to get down). As a result I stayed with softer foods (such as high Protein versions of chili and soups). I have included a few recipes at the end of the following article. http:// http://www.breadandbutterscience.com/Surgery.pdf

Also there is no reason to accelerate your transitions to solids. Just take your time.

So to answer your original question. It is difficult to answer. If you are unable to get down liquids then I would suspect a stricture. If you are unable to get down even small amounts of pureed foods, I would suspect a stricture. But your problem may be that you are transitioning to solids too soon.

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James I am this morning considering writing an open letter to my surgeon/endoscopist, if it sounds good I will submit,it,on here, okay?😝

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Well here is my open letter to my Surgeon/Endoscopist and I will give her a copy,of this. And @mouseCat🐭🐯 I hope you are monitoring this- maybe this will help?
Dear Doctor Noria
First I like you, I respect you, I appreciate what you gave done this far but after 3 attempts it does not appear mine will be an easy Stricture solution. You have MANY cases to ponder, I have only ONE-MINE!
Some thoughts come to mind. You have stated on your print-outs with pictures each time that my esophagus is clean and normal and you believe Precious Pouch is of normal dimensions. These are reassuring things to know. Yet she remains a Gastric Problem Child.
Innervation- I am aware the gastrointestinal system has peristalsis- churning motion of digestive contents and then movement on- when Dr Needleman (blessings be to him!) sectioned off Precious Pouch with his Magic Stapler, did he destroy her churning and motility? If there were nerves severed , will they regenerate or will she remain a non- functioning wart and receptacle only in my abdomen?
While doing your procedures have you insufflated her with air, does she have any flexibility, any expandability? I know to you 9 weeks is Early Days, but to ME it is my whole life. Can she hold or will she ever even hold more than the fabled 2 ounces we taught to sip while still in the hospital?
Liquids- have you instilled any liquids in Her? Yes I know Leak and stretching tests are more for VSG to test strength of suture lines but maybe She would benefit from this?
Contrast mediums -Hmmn? How about instilling some, fluroscope or similar equipment- see how long she can hold things, how quickly She drains. Pulling a figure out of thin Air- say it takes the average pouch an hour to an hour and a half to drain- if Precious drains in 15 minutes or takes close to 2 hours, more study,may be needed. Something else to check out?
Are stomal strictures ever stented like cardiologists do blood vessels? Would Precious and I benefit from this?
And finally, I am reminded of one of your former countrywomen ( Doctor Noria is actually Canadian , did her pre-training in Toronto) , she lives in New Brunswick, outside of Fredricton. She had a cervical restriction ring, while trying to produce,her 2 daughters she would dialate to 6cm and then it would tighten right back down. Amy Catherine and Alice Victoria were both born by C-Sections. Now I know an Uterine Cervix is a natural orfice whereas a Stoma is a surgical-produced one, but is this outside the realm of possibility, probability, or even conjecture?
I know you and Doctor Needleman, my surgeon, your partner, are going to talk over my case. Although you were not in the room that surgery day, you know his work and know it well. Anything you 2 come up with to do to me , I will accept gladly. I was going to say NO OPEN SURGERY but if you happened to notice I have a right paramedian scar, I healed 1 open incision just dandy, I can do it again if necessary. I'll even offer a bonus, if you're feeling groggy that day, call gyn in , after fearing a hysterectomy for years, having multiple PCP threaten me with it, I offered my uterus to an OB/Gyn. in my city, Mount Vernon, Danged fool didn't Want It. Made a wisecrack about only having 1 husband, not enough wear and tear he thought to justify it. So if you needed to OPEN me up, you can have anything superfluous except my 3 kidneys, them I am proud of, and my MINOR CLAIM TO GLORY! Tell those vultures on the Transplant Teams, I'm over 70, they are mine ,all mine, and although I might have shared in my Youth NO MORE!
The DoorKeeper and Bouncer for Club Stricture. Frustr8👈😝👉

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Frustr8, I had one suggestion. I am not really familiar with your case but I wanted to make sure that one more base was covered.

According to the internet:

Nausea and vomiting are the most common complaints after bariatric surgery, and they are typically associated with inappropriate diet and noncompliance with a gastroplasty diet (ie, eat undisturbed, chew meticulously, never drink with meals, and wait 2 hours before drinking after solid food is consumed). If these symptoms are associated with epigastric pain, significant dehydration, or not explained by dietary indiscretions, an alternative diagnosis must be explored. One of the most common complications causing nausea and vomiting in gastric bypass patients is anastomotic ulcers, with and without stomal stenosis. Ulceration or stenosis at the gastrojejunostomy of the gastric bypass has a reported incidence of 3% to 20%. Although no unifying explanation for the etiology of anastomotic ulcers exists, most experts agree that the pathogenesis is likely multifactorial. These ulcers are thought to be due to a combination of preserved acid secretion in the pouch, tension from the Roux limb, ischemia from the operation, nonsteroidal anti-inflammatory drug (NSAID) use, and perhaps Helicobacter pylori infection. Evidence suggests that little acid is secreted in the gastric bypass pouch; however, staple line dehiscence may lead to excessive acid bathing of the anastomosis. Treatment for both marginal ulcers and stomal ulcers should include avoidance of NSAIDs, antisecretory therapy with proton-pump inhibitors, and/or sucralfate. In addition, H pylori infection should be identified and treated, if present.

I just wanted to make sure you were tested for Helicobacter pylori infection. This is a fairly common infection. About 50% of the worlds population has it. The symptoms are exasperated by gastric bypass surgery. It is a simple tests. But if you have it, it will be a little difficult to kill this bug. It will take a cocktail of antibiotics to treat and the initial treatment may not kill the infection and you might have to take a second round.

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“Thank you everyone. Liquids are fine and I'm supposed to be on soft solid foods but maybe I'll give it another few weeks before eating certain things”

Hi
I wouldn’t consider chicken “soft”.... it’s probably just too dense to eat right now! Try ground turkey with a bit of spaghetti sauce? Sometimes just having some liquid on it like sauce makes it easier

Good luck!

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Thanks James for weighing in , I really value your insight on so much. In Fact when I saw it was you responding, I said" Frustr8 You finally have arrived!"
To answer you, yes I definitely was tested last November(2017) by my gastroenterologist when he discovered Hector my little baby ulcer with my gastritis, I was negative for h. Pylori, that's why the determination was made that he probably was due to excessive NSAID usage. My ortho suggested almost daily usage of ibuprofen for chronic arthritic pain, PCP said, since you are a BIG 👧, you can easily handle a 4 at time dosage, Thanks guys for your faulty advice! When I first complained of gastro symptoms to PCP he put me on Prilosec,(omeprazole)-- when symptoms didnt seem to alleviate is when I first visited Dr Mujataba, my gastroenterologist. And although the sequence is to have your Primary Care refer one to a specialist, I marched in on my own, because to be honest I was peeved at PCP and his danged omeprazole that was enriching the pharmacy coffers and doing nothing much for me. FYI I do not believe that blasted drug is gastroprotective for ME.

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I was on Dexilent next, took it faithfully, felt results were good, was faithful up into my bariatric surgery time. Afterward what should rear it's ugly head but omeprazole. Oh no no, I told them THAT doesn't work for me. Their excuse: you can open those capsules and pour it on food or stir into applesauce. Moot point on the capsule opening, I was willing to cut the Dexilent capsules open if that was the rationale.Why not give me something that works instead of that stuff. But they insisted and I finally bent,to their will. 2 weeks in I stated THERE IS SOMETHING WRONG, and at first I was poo!pooed, You're swollen, give yourself time to heal, you're imagining things, my favorite We Are The Bariatric Weight Team, We Know What Is Best For Your Body, yeah Your Degree- My Body! Finally, I suspect, to shut me up they scheduled me an endoscopy, an EGJ, because of course, a bypassers duodenum is never easily visualized again, only the jejunem can be, the price RNY pays. And who was right? ME ME ME! I have lived in this body many years, give me a little credit please! And in addition to the stricture I thought I hand who should be there except 5 new nasty little ulcers 2 in the pouch near the stomal openings and 3 more on the back wall of the,jejunem, all grown with daily dosing of omeprazol. I have had scoping 12th October, 26th October, 9th November and another 23 November, just don' t
have designated time yet. And,last time Dr Noria stated the ulceration is worse, I cannot longer be in the presence of an active smoker, indeed not even someone who has tobacco residue on their clothing, I am not yet bleeding or ready to perforated but who knows?
Of the precipitating risks? Ischemia from the operation, Roux limb tension, dehydration, difficult to move past when Precious Pouch accepts no more than 3 ounces of anything without active rebellion. And after 10+ weeks it is emotionally wearying, so I have gone back to mini-cup therapy every 15 minutes, manage to get medications, Vitamins, minerals in , thing,i may be living on them instead of effective calories. And since I am still on a limited Stage 2 diet it is difficult to be dietarily indisecreet.
I have been on Zofran 3 times daily, now have added Carafate every 6 hours around the clock.
James I would like to receive some,joy by now! I am dropping weight like an anorexic sailor, I'm tired, dizzy if I exercise very much. Clothes much looser, some people have noticed my weight loss, the average person can't be bothered to care.
And I keep on keeping on and yearn for a change.😙😉😳😜

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Wait until you start dropping clothes sizes. I went from a 3X in shirts down to a size small. That was JOY.

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And an update from me. Went for my endoscopy( lifetime #7) on November 28th, did not have happy news, ulcers had worsened , got sent upstairs to an in-patient bed, and spent a Week as the guest of Ohio State University-Wexner Medical Center, trala tra la! Late Thursday November 29th. at about5:15 pm EST, I became the quasi-proud possessor of a PICC line in my upper left arm, for those so inclined to know, it is in my basilic vein, snakes through even increasing vein diameters into the Superior Vena Cava,, when the catheter end is only skoosh away from my Atrium of my ❤. Yeah rather Scary Larry when you consider it!
You see,on my limited liquidy diet, because Precious Pouch accepts none other, and "She must be obeyed", peeved and irritated as she is, my ulcers were refusing to heal. To insure that I would need between 90-120 grams orally, wasn't going to happen so I was being fed by TPN, started out 24 hours,then cycled back until 12 on, 12 off at dismissal December 5th. Now that I am homeand using a battery-pack pump it is 14 on, 10 off. And I gradually am,coming to accept it as a way of life. Oh it can be a nuisance having a tail to constantly consider, you pee a lot because it is a 3 liter bag, sure can't. have uninterrupted slumber unless you enjoy lying in a puddle. Most of the time I wear it in a black backpack, take it off And lay it on bedside table while I TRY to sleep. Weighs between 8-10 pounds, try to not lose your balance swinging it back on,lostmine and ended up sitting,on the cold tiled bathroom floor. That took some fancy maneuvering to keep from using my left arm to get up. Tomkitten says if he had only recorded it on his cell phone, YouTube would have put it on! Might have started a Blog",My Mom, the PICC line and Me". Guess his fame and fortune will be coming later. Soonest it might come out? After Christmas when I have another Endoscopy on December 28. Was hopeful until last night and today when I am having some puking. Gosh I hoped THAT was over! But I'll keep keeping on and we shall see!

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That is awful, you really aren’t doing well are you. Surely it must be time for your luck to change

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Oh it will, I am stubborn, I am going to win, just convince my Body of that!

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And today I am reaping the whirlwind, it's mostly my fault. Tomkitten has a lovely bunch of bananas sitting out in the kitchen, He Came ambling by eating,one, so Dumb Dora wanted some. Asked him to cut me off a small chunk. Why oh why could I not remember I comitted the last time I had any banana even in a shake or smoothie? Guess I thought because it was a while back I had healed? Duhh, now I am puking and # 2 ever time a new retch comes. Luckily I have an Adult,pull-up on. One of my more warped friends gave me a large package as a gag gift when I had my RnY, maybe thought it was the same as hemorrhoid surgery? Well shoe on other foot, or more exactly on my rump. And I have gone down to singleX or XX, the triple XXX dropped off! So note to self- Leave those all verdompt bananas🍌Alone. It just ain't worth it!

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