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Does one more bite=stretched stoma?

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Okay, I've done it....I've begun getting that hyper paranoia that goes hand in hand with the unflinching NEED to succeed at this surgery. Now, I'm wondering (after my itty bitty weight gain this week) whether my stoma is stretched.

I haven't felt as much "restriction" lately when I eat. So, the natural question: Is this because I've learned to eat the appropriate amount of food for my pouch or is a stretched out stoma the culprit?? I read a post from a WLS patient who happened to be a physician....he was responding to someone else's paranoid stoma-stretching rant. He wrote the words that have been HAUNTING me for the past couple of days, (I'll try to write them as exact as I read them, but don't quote me.) "If you begin to feel satisfied, take one more bite and you're well on your way to a stretched out stoma."

ONE MORE BITE??? OH.MY.GOD. What are the odds that I've had one bite too many?? Pretty high, actually. Don't get me wrong, I don't eat by the restriction method. But, there are times that I haven't measured, and there are times that my 1/4 C of food left me satisfied BEFORE I finished it. So, the "one more bite" thing is a pretty substantial warning, for sure!!!

The very last thing that I want to have happen is to become that statistic.....the one that regained all of her weight after 2 years of losing it all. The theory that I've heard repeatedly is that most of these "failures" are caused by stoma-dilation. So, the questions are mounting:

How easy is this to do?

Surely, that kind of damage would hurt, right??

Are there symptoms that it's happening before it's too late?

Can we get testing to find out if it's happening to us?


I've read about the injections that some people have done via endoscopy to create scar tissue to restrict the stoma. And, I've read all about the Rose procedure. Both articles brought me HUGE amounts of relief, BUT I'd still like to be fully aware of the signs and symptoms of stoma dilation LONG BEFORE any repair work is necessary.

Does anyone have info on this? I'm simply not finding any clear-cut facts....and I'm the kind of gal this is reassured by cold, hard facts, regardless of how cold and hard they are. Plan for the worst, hope for the best.

Uber-paranoid plan: Slow meal times back down to 30 minutes. Turn off all distractions so I can fully tune back in to my pouch. Limit ALL intake to 1/4 C. Stop drinking 15 min before eating. (a rule that some people have in their plans but is not in mine....I do wait 1 hour after eating to drink)

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I just read two journal articles in order to get some "official" insight into the questions here. I have the same fears and so you kind of forced me to look into it since I can make myself do what I have been avoiding in order to provide info to a friend. The question of whether it's even possible to keep the weight off in the long term, much less whether I can keep it off in the long term, is one that frightens the crap outa me. Thus, the avoidance.

So, what I found is just as scary as before:( simply because it all depends on a few things:

1. mainly, our own compliance and sense of responsibility--following the major rules: SLOW eating- even in the long term, maintaining portion control, staying away from sugary foods, and NOT DRINKING WITH MEALS, additionally, many papers indicate most weight gainers drink soda (diet or not) again--I will never do that!

2. genetics- a recent article actually identified genetic markers that predict how much of our excess weight we will lose. This is new big news!

3. luck and time--it looks like the pouch increases in size naturally over time but much more quickly in noncompliant folks. But that it's noncompliance that affects weight loss and gain, not pouch size. The stoma size in the first 2 years doesn't seem to affect weight loss, but over time, stretching of the stoma CAN contribute. This is the scary part: While noncompliance (especially eating fast and drinking with meals) can cause the stoma to stretch quickly, it looks like simply time can cause a nonreinforced stoma to stretch also. The authors suggested that only reinforcing with staples prevents stoma dilation from happening with time. Now, that was just one study, and the authors may have had an agenda, perhaps introducing a new technique, but the overall take away I get is this: IT'S ON ME to be sure to follow the rules--eat slowly (I need to work on this one), eat small portions, avoid soda and sugar, and no drinking with meals. Your uber-paranoid plan sounds like just what the doctor ordered.

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I am not sure I will sleep tonight....but THANK YOU both for bringing this to my attention...I had no idea.

I am still in my honeymoon period but absolutely militant about never going back to the physical, mental and emotional hell-hole I was in before. If that means joining the ranks of the uber-paranoid, then so be it.

I'll take it over failure (especially preventable failure) any day.

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