I have my best friend, Ruth, to thank for this:
from thesundaytimes
JUNE 26, 2004
Our Columnist
When meals are hard to stomach...
By Andy Ho
MANY readers were quite taken aback by a recent letter in The Straits Times' Forum Page ('Patients need better support after surgery', June 19) that revealed how the writer's mother had had an operation in which her entire stomach was removed because of cancer. The first question callers asked was: 'How does the poor woman eat?'
With some difficulty. In fact, that was precisely why the letter writer, Ms Angeline Ang, aired the problem in public. Her mother now has a dramatic digestive problem called the dumping syndrome, for which her medical team had not adequately prepared the family, it seems.
Ms Ang said, rightly, that the surgeon or dietician should have explained any necessary dietary changes before the surgery, with intensive nutritional follow-up after the procedure.
But first what is dumping?
This refers to (whatever is left of) the stomach dumping or emptying its contents immediately into the intestines so the latter fills up too rapidly with liquid and undigested food. During a meal, the tummy very quickly feels full and starts making growling sounds (called borborygmi). The patient will feel nauseated and may belch, vomit or develop cramps and explosive diarrhoea.
If dumping happens later - say, one to three hours after eating - she may develop a rapid heartbeat, break out in sweat, and feel flushed, weak and breathless. She could also feel lightheaded or dizzy, have fainting spells and an intense desire to lie down.
Dumping is not dangerous, but is frightening. So where do these troubles stem from?
One clue lies in the fact that foods containing high amounts of sugar often make the symptoms worse. Sugars attract water. High concentrations of simple sugars in the undigested food exiting the stomach rapidly attract a lot of fluid into the intestines. That fluid races in from your blood, so the volume of blood circulating actually drops.
The undigested food and liquid dumped into the intestines distend it, causing problems like cramps and bloating. The rush-in of water and the resulting drop in circulating blood volume causes palpitations and lightheadedness.
That is the conventional explanation, anyway. Today, researchers are also looking into whether an overly rapid release of gut hormones also plays a role. If so, there may be treatment.
Another question the readers who called up about the letter had: Are there any drugs that help?
Dietary prohibitions and instructions are probably more important than drugs in managing the problem. Patients must eat several small meals throughout the day - say six - and avoid foods that contain sugar.
Protein and fat intake should be increased to fulfil energy needs but milk and milk products may cause gas and should be avoided.
Patients should also not drink at mealtimes, to reduce the fluid rushing into the intestines, but instead drink small amounts of liquids throughout the day. Adding dietary fibre like pectin or guar gum that form gels with carbohydrates can slow down sugar absorption and make the food take a longer time to pass through the bowels.
But, yes, there are now some drugs that do help. One that definitely helps is acarbose, made originally as an adjunct treatment for diabetes. Always taken with the first bite at every meal, acarbose acts by slowing down the digestion of carbohydrates. In this way it reduces the sugar load reaching the intestines. This prescription drug has been proven in rigorous experiments to slow down the digestion of starches.
Before you get all excited and think that this sounds a lot like those mass-marketed weight loss pills called 'carb blockers', note that acarbose slows down - but does not block - the digestion of carbohydrates. Rigorous studies have not found any weight loss with its use.
Its main side effect is delayed tummy problems, because when starches and sugars pass through the intestine undigested, they are greeted by lots of bacteria and yeast that digest them by fermenting them. This produces lots of carbon dioxide, so you get bloating, gas, and abdominal discomfort.
But these symptoms with acarbose do tend to decrease over time. Also, the patient must avoid some Chinese herbs such as ma huang and ginseng when taking acarbose.
Why some patients remain asymptomatic after gastric surgery, while others develop severe dumping remains unknown. Ms Ang should remain hopeful, as most patients afflicted with dumping do improve over time: Symptoms usually disappear in three to 12 months, but they also can be permanent.
_______________________________________________
Mr Ho is a great and kind man. He has offered me a wealth of info that I never knew up to now. Yes, even now. I have never knew that the drug existed As far as dietary advice goes, he's more helpful than that surgeon, doctor and dietician put together. I have to write a love letter to the guy to thank him.
I'm grateful, Mr Ho. Thank you for highlighting my problem to the public once again, especially after that horrendous and appalling reply by SGH (see below). Thank you for making me feel my letter has struck a cord and the community has been alerted to something important. My mum's condition is not trivial; my concerns were honourable and valid; and SGH is a piece of shit for crafting that deceitful and smug reply. I feel vindicated by your column. Most of all, I have dietary information to work on and I hope my mum's health can improve subsequently.
Addendum: Oops. He is Dr Ho. A Ph.D from M.I.T. (Courtesy of Shinhao)
*
And now time for a bastard's reply in The Straits Times forum. I think I will put this up after all:
JUNE 26, 2004
Patient given post-surgery health info
I REFER to Ms Angeline Ang Siau Wei's letter, 'Patients need better support after surgery' (ST, June 19).
Our staff provided pre- and post-operative information and dietary counselling to Ms Ang's mother personally during her hospital stay as well as contact details for any clarifications.
While the information provided in the diet sheet detailed nutritional care guidelines, an individualised meal plan tailored for Ms Ang's mother with examples of food items was explained to the patient before discharge.
However, we sincerely apologise if the information given to them was deemed inadequate. We have since contacted Ms Ang and arranged a meeting to further understand her concerns.
We wish to thank her for her feedback. We will continue to improve and strengthen our patient education programmes.
FOO HEE JUG
Chief Operating Officer
Singapore General Hospital
_________________________________
What a lousy piece of shit. Liar. My mum was not offered any pre-operative information and counselling. There was less than 24 hs before her hopitalisation and the operation. The whole thing happened too fast and sudden, such that we were totally caught unaware, and only can depend on the doctor's words. No time to react, probe and check because we were so worried and ignorant (then). We only had trust, not the vital and necessary information and counselling.
He said it would be okay. Just remove stomach. Still can eat and lead normal life. Period.
We were neither warned nor prepared for the horrific consequences of the operation.
And after the operation, you guys know what happened, as I wrote to the forum. Even that lousy "individualised meal plan", "tailored" so-called, was given to us after we requested for it. NOTE: We requested for it. It was not offered to us of their own initiative. And even then, that stupid dietician took close to two hrs to pen that.
Other than the dietician, there was no one to provide any other forms of post-operative information of any sorts. There were no contact details for clarification. Nada. Zilch. None, okay. My mum said nobody told her anything.
At any rate, you should have contacted me (and I wasn't contacted) about everything. I left you my bloody mobile no. and my phone is on 24 hs all the time. Why tell it to a patient who is already extremely weak and fatigued after the operation?
"...we sincerely apologise if the information given to them was deemed inadequate..."
Fuck you. It was scanty to the point of negligible. What deemed. It simply, is, was, inadequate. Period.
from thesundaytimes
JUNE 26, 2004
Our Columnist
When meals are hard to stomach...
By Andy Ho
MANY readers were quite taken aback by a recent letter in The Straits Times' Forum Page ('Patients need better support after surgery', June 19) that revealed how the writer's mother had had an operation in which her entire stomach was removed because of cancer. The first question callers asked was: 'How does the poor woman eat?'
With some difficulty. In fact, that was precisely why the letter writer, Ms Angeline Ang, aired the problem in public. Her mother now has a dramatic digestive problem called the dumping syndrome, for which her medical team had not adequately prepared the family, it seems.
Ms Ang said, rightly, that the surgeon or dietician should have explained any necessary dietary changes before the surgery, with intensive nutritional follow-up after the procedure.
But first what is dumping?
This refers to (whatever is left of) the stomach dumping or emptying its contents immediately into the intestines so the latter fills up too rapidly with liquid and undigested food. During a meal, the tummy very quickly feels full and starts making growling sounds (called borborygmi). The patient will feel nauseated and may belch, vomit or develop cramps and explosive diarrhoea.
If dumping happens later - say, one to three hours after eating - she may develop a rapid heartbeat, break out in sweat, and feel flushed, weak and breathless. She could also feel lightheaded or dizzy, have fainting spells and an intense desire to lie down.
Dumping is not dangerous, but is frightening. So where do these troubles stem from?
One clue lies in the fact that foods containing high amounts of sugar often make the symptoms worse. Sugars attract water. High concentrations of simple sugars in the undigested food exiting the stomach rapidly attract a lot of fluid into the intestines. That fluid races in from your blood, so the volume of blood circulating actually drops.
The undigested food and liquid dumped into the intestines distend it, causing problems like cramps and bloating. The rush-in of water and the resulting drop in circulating blood volume causes palpitations and lightheadedness.
That is the conventional explanation, anyway. Today, researchers are also looking into whether an overly rapid release of gut hormones also plays a role. If so, there may be treatment.
Another question the readers who called up about the letter had: Are there any drugs that help?
Dietary prohibitions and instructions are probably more important than drugs in managing the problem. Patients must eat several small meals throughout the day - say six - and avoid foods that contain sugar.
Protein and fat intake should be increased to fulfil energy needs but milk and milk products may cause gas and should be avoided.
Patients should also not drink at mealtimes, to reduce the fluid rushing into the intestines, but instead drink small amounts of liquids throughout the day. Adding dietary fibre like pectin or guar gum that form gels with carbohydrates can slow down sugar absorption and make the food take a longer time to pass through the bowels.
But, yes, there are now some drugs that do help. One that definitely helps is acarbose, made originally as an adjunct treatment for diabetes. Always taken with the first bite at every meal, acarbose acts by slowing down the digestion of carbohydrates. In this way it reduces the sugar load reaching the intestines. This prescription drug has been proven in rigorous experiments to slow down the digestion of starches.
Before you get all excited and think that this sounds a lot like those mass-marketed weight loss pills called 'carb blockers', note that acarbose slows down - but does not block - the digestion of carbohydrates. Rigorous studies have not found any weight loss with its use.
Its main side effect is delayed tummy problems, because when starches and sugars pass through the intestine undigested, they are greeted by lots of bacteria and yeast that digest them by fermenting them. This produces lots of carbon dioxide, so you get bloating, gas, and abdominal discomfort.
But these symptoms with acarbose do tend to decrease over time. Also, the patient must avoid some Chinese herbs such as ma huang and ginseng when taking acarbose.
Why some patients remain asymptomatic after gastric surgery, while others develop severe dumping remains unknown. Ms Ang should remain hopeful, as most patients afflicted with dumping do improve over time: Symptoms usually disappear in three to 12 months, but they also can be permanent.
_______________________________________________
Mr Ho is a great and kind man. He has offered me a wealth of info that I never knew up to now. Yes, even now. I have never knew that the drug existed As far as dietary advice goes, he's more helpful than that surgeon, doctor and dietician put together. I have to write a love letter to the guy to thank him.
I'm grateful, Mr Ho. Thank you for highlighting my problem to the public once again, especially after that horrendous and appalling reply by SGH (see below). Thank you for making me feel my letter has struck a cord and the community has been alerted to something important. My mum's condition is not trivial; my concerns were honourable and valid; and SGH is a piece of shit for crafting that deceitful and smug reply. I feel vindicated by your column. Most of all, I have dietary information to work on and I hope my mum's health can improve subsequently.
Addendum: Oops. He is Dr Ho. A Ph.D from M.I.T. (Courtesy of Shinhao)
*
And now time for a bastard's reply in The Straits Times forum. I think I will put this up after all:
JUNE 26, 2004
Patient given post-surgery health info
I REFER to Ms Angeline Ang Siau Wei's letter, 'Patients need better support after surgery' (ST, June 19).
Our staff provided pre- and post-operative information and dietary counselling to Ms Ang's mother personally during her hospital stay as well as contact details for any clarifications.
While the information provided in the diet sheet detailed nutritional care guidelines, an individualised meal plan tailored for Ms Ang's mother with examples of food items was explained to the patient before discharge.
However, we sincerely apologise if the information given to them was deemed inadequate. We have since contacted Ms Ang and arranged a meeting to further understand her concerns.
We wish to thank her for her feedback. We will continue to improve and strengthen our patient education programmes.
FOO HEE JUG
Chief Operating Officer
Singapore General Hospital
_________________________________
What a lousy piece of shit. Liar. My mum was not offered any pre-operative information and counselling. There was less than 24 hs before her hopitalisation and the operation. The whole thing happened too fast and sudden, such that we were totally caught unaware, and only can depend on the doctor's words. No time to react, probe and check because we were so worried and ignorant (then). We only had trust, not the vital and necessary information and counselling.
He said it would be okay. Just remove stomach. Still can eat and lead normal life. Period.
We were neither warned nor prepared for the horrific consequences of the operation.
And after the operation, you guys know what happened, as I wrote to the forum. Even that lousy "individualised meal plan", "tailored" so-called, was given to us after we requested for it. NOTE: We requested for it. It was not offered to us of their own initiative. And even then, that stupid dietician took close to two hrs to pen that.
Other than the dietician, there was no one to provide any other forms of post-operative information of any sorts. There were no contact details for clarification. Nada. Zilch. None, okay. My mum said nobody told her anything.
At any rate, you should have contacted me (and I wasn't contacted) about everything. I left you my bloody mobile no. and my phone is on 24 hs all the time. Why tell it to a patient who is already extremely weak and fatigued after the operation?
"...we sincerely apologise if the information given to them was deemed inadequate..."
Fuck you. It was scanty to the point of negligible. What deemed. It simply, is, was, inadequate. Period.
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