Help in advising PCP about stomach scan

[Clematis]

At 7+ months out, I still cannot eat even an ounce of thoroughly masticated dense protein without stomach discomfort and usually puking. I thought the puking was getting better but then realized I have subconsciously trained myself to just not eat protein. I have a protein drink for breakfast, a piece of toast with peanut butter or a protein bar for an early lunch, a single serve bag of popcorn early afternoon, and when I come home from late afternoon exercise class, I have a protein drink and later maybe greek yogurt. I don’t really eat dinner anymore. (I used to eat a lot of almonds but have noticed a link to that and a rash on my face so I may have developed a sensitivity or an allergy.) I’m not even sure it’s “dense” protein as just dipping a strip of buttered toast in the runny yolk of a soft boiled egg can cause my stomach to seize. Sometimes I can eat cheese, but more often, not. There was a time when I could eat Wendy’s chili (as in 1/3c) or chicken nuggets (as in 3 or 4) but now I can’t eat more than a spoonful of chili or one single nugget, and I have discomfort. I made a pot roast this weekend and cooked it until it was just this side of mush — two bites sat brick-like in my stomach for an hour before I barfed it up. (I don;t think this is a volume issue as I can get a single serve bag of popcorn without feeling full.) A week ago I was able to eat 1/4 of a bratwurst (uncomfortable but it stayed down) but I haven’t been able to do that again. I don't consider it an accomplishment that I can sometimes keep protein down but spend 90 minutes curled in a chair fighting nausea. When I lowered from prescription dose to OTC dose of PPI it seemed to help a little bit — I thought but now I’m not so sure. If all I can eat are carbs without discomfort and puking, I feel I could end up on a slippery slope.

I’d like to know WHY dense protein is so difficult. What are the medical reasons for this so I can lucidly explain it to my PCP? For a year now I have read the posts of DS patients on this board of their “trouble” with dense protein (without definition of what they mean by “trouble” — are they vomiting? in discomfort?). And so far I’ve seen no one explain, medically, WHY this occurs.

I see my PCP on Thursday. I only saw her once in January where I mentioned the dense protein issue, but it was still early post-op so we both were not concerned. She has never had a WLS patient of any kind, nor has she heard of DS. So far she has been very gracious about ordering labs and I don;t want to rock the boat.

I’m sure she would order a stomach scan to see if my sleeve is a figure 8 shape or twisted… but is that what could cause this? Instead, is this an issue with my pylorus? WHAT should she be looking for? What type of scan should she order? If the contrast medium is like yogurt, it’s just going to swirl on down and out. Is there such a thing as chunky contrast that would simulate dense protein to see how the pylorus is working?

Any advice you can give me for how to advise her on how to manage this would be appreciated.

 

[Larra]

The 2 best ways to look at your sleeve, which is where the problem seems to be, would be UGI x-rays and/or upper endoscopy. It sounds like you might have a stricture. They are much less common with DS than with gastric bypass, but they do occur.
The contrast used with UGI x-rays is thin liquid, but would still show a stricture either in the sleeve itself or at the DI anastomosis. Either test would also assess the size of your sleeve, though I think a sleeve size issue is less likely.

 

[ampt]

I had trouble with dense protein, too. It did make me vomit on occasion, or just a general feeling of yuckiness ("DEAR GOD! WHAT DID I DO!?"). My only thought, without doing research on it, is that everyone's stomachs heal differently, and some can handle dense protein sooner than others. My hardest food was steak. It took about 6 months before I could eat it. It sounds like you are not getting enough protein!!

You don't want to rock the boat? YOU SHOULD. It is your health here. Is there not a doctor near you that has had a WLS/DS patient before? She could order a CT scan with contrast: you literally sit by the CT machine, ingest the fluid (Mylanta chalky taste and consistancy) and they take the images right away. She can visualize the stomach this way, but it may or may not explain the dense protein issue. She should probably find and consult a doctor that has experience in this field.

 

[DSRIGGS]

I have an Upper GI series and EDG. Both are a piece of cake, but you do have to swallow a barium mixture doing the Upper GI that Larra discussed. You wallow a mouthful and the radiologist is right there watching it go through and snapping pictures. Both tests are quick an easy, so I would highly suggest ask for one and if it shows nothing then get the other. I went to a GI for these issues and the guy was very helpful.

I hope you can get this figured out soon.

 

[Clematis]

Thanks everyone. I wasn't sure what kind of scan I needed so this info was very helpful.

I think I'll start with asking her to order a UGI scan. I had a fluoroscope in MX 3 days post-op so am familiar with the liquid chalk barium. Then if there is an issue on the radiologist's report, I can get a referral to see a gastroenterologist for an endoscopy. Since this is strictly a sleeve issue, I might even go through a local established bariatric center that does sleeves (they don't do DS) as they might recommend a gastroenterologist with extensive sleeve experience.

By "rock the boat" I mean overwhelm my PCP and have her say she doesn't feel comfortable wrangling WLS issues at all and no longer ordering labs. I met her only once in January and she xeroxed the generic lab order I brought her without dispute. As long as I can give her data so she feels she is not doing something medically ill advised, she will be OK. It is impossible to find a decent PCP taking new patients, much less one that is pro-WLS. My former PCP told me a month before the surgery that she didn't "believe" in WLS (she had never had a WLS patient nor had she heard of DS) and she would not support me with labs or complications. It took me two months to find this new PCP. I don't want to lose her.

Some good news: I had DS done self-pay, but I think my insurance will cover whatever needs to be tested or remedied as long as I'm not in-patient. At least that's what it says in the EOC according to me and my attorney husband.

I'd just like to feel normal while eating protein. I have been avoiding meals in someone's home since last October when I started the pre-op diet. I can usually find something on a restaurant menu that I can push around the plate and wrinkle my nose and say it's not good, but I can't do that at someone's home without offending them. I stayed home "sick" and sent my family on to a cookout last week where they were serving hamburgers, pasta salad and crudités -- none of which I can eat. I have been putting off going out of town to visit family and friends because they're the types that will want to cook at home. (No one knows about my WLS.) I'm still scheduled to go to Europe for the month of October which includes 2 weeks in Greece with all meals included -- fixed menu meals, so I could die of starvation if I don't get this settled by then.

This protein thing has been the only downside to my DS.

 

[DSRIGGS]

Yes you deserve to get able to eat meat and not hurt or throw it up.. I think starting with the upper GI is a good plan. Best of luck to you darlin.

 

[ampt]

By "rock the boat" I mean overwhelm my PCP and have her say she doesn't feel comfortable wrangling WLS issues at all and no longer ordering labs. I met her only once in January and she xeroxed the generic lab order I brought her without dispute. As long as I can give her data so she feels she is not doing something medically ill advised, she will be OK. It is impossible to find a decent PCP taking new patients, much less one that is pro-WLS. My former PCP told me a month before the surgery that she didn't "believe" in WLS (she had never had a WLS patient nor had she heard of DS) and she would not support me with labs or complications. It took me two months to find this new PCP. I don't want to lose her.

I understand now! LOL Yes, having a doctor that may not be too experienced with WLS and DS but willing to listen and take action would be preferable to one that is completely unsupportive of your choice to have a DS. Good luck. I hope you find out what is going on!