October 8, 2012

How do you live without your stomach?

I was wondering, after reading about this poor young woman who had her stomach removed to save her life after she drank a cocktail that contained liquid nitrogen:
"This girl is the victim of an irresponsible alcohol industry that's now competing on gimmicks. People should not be playing chemistry in public houses. This is a very, very cold substance and it is similar to subjecting your oesophagus and stomach to frost bite."...
[L]iquid nitrogen - which vapourises at -196C - has been increasingly used in recent years in the preparation of drinks. It is used to chill glasses and is a crowd-pleaser thanks to the dramatic-looking water vapour it releases at room temperature.
I found this article "Life without my stomach" about a women who, at the age of 27, opted to have her stomach removed because she had the gene for a form of stomach cancer that would kill her if she waited for it actually to develop, which was 90% likely, given the gene. So, then, how do you eat?

As my stomach had been cut out, part of my small intestine was joined directly to my stomach in what is called a Roux-en-Y reconstruction. Without a stomach, my food passed directly from my oesophagus into my small intestine.

With time, I was told, the body would adapt; the small intestine would make a small pouch where food could be stored a little longer (mimicking the stomach), before it continued on its way. It is one of the human body's remarkable survival mechanisms.

Weighing about eight stone, I could not afford to lose much weight. The doctors were concerned about this, so I went home with a feeding tube inserted into my bowel. It was attached to my body just above, and to the left, of my belly button with three little stitches and a plastic triangle. I was to hook it up to a machine each night, which would drip food into my bowel, bypassing the area on which I was operated. I never liked feeding that way because I always woke up feeling really full.

But I didn't have to rely on this for long. Soon, I was also managing to eat small amounts, which meant that I had to eat often. After experimenting, I found I could eat whatever I wanted, and it didn't seem as if there were any particular foods that were going to upset me. I have always enjoyed eating healthily, so I was happy I could still take pleasure in a bowl of fruit and yogurt in the morning.

Given that I was eating so well, it was not long before my feeding tube was removed. To this day, I am really lucky in that I can eat any foods I want. The only difference now is that I eat slightly smaller portions....
Sometimes adhesions cause intense pain and she has to stop eating and drinking and take painkillers and, if the pain doesn't end, go to the hospital. "I can't say this doesn't worry me; I really don't want to be a sick person." She's not yet able to live independently, and she wonders about having children, but only because the condition is genetic. "And, in response to the question as to whether I regret my decision to have my stomach removed, my answer is simple – no way."

53 comments:

Inga said...

Many obese patients have had the Roux-En-Y, or another form of bypassing the stomach to go on to losing weight very successfully. They regain their health and are forced into eating healthier foods. Sometimes they have issues with absorption of nutrients, but if they follow carefully their post op eating program, most do extremely well.

Inga said...

I understand this wasn't the issue with these women.

Ann Althouse said...

"Many obese patients have had the Roux-En-Y...."

Oh, my lord! What a crazy world! How horrific to remove the stomach just for weight loss!

chickelit said...

I'm surprised they didn't use dry ice instead of liquid nitrogen (LN2). Dry ice gives the same Dr. Jekyll potion look to a water-based drink and is easier to handle than liquid nitrogen which requires special Dewar flasks (insulated thermos) to handle.

I'm surprised she was able to ingest LN2. Dry ice (CO2) is still not something you'd want to ingest. It too "burns".

Ann Althouse said...

"I'm surprised they didn't use dry ice instead of liquid nitrogen..."

I'm guessing it's felt to be more elegant and "scientific."

Dry ice is just low-class theatrics.

But liquid nitrogen is like diamonds.

Sofa King said...

I can state with some authority that it is possible to swallow pill-sized chunks of dry ice (with water) and belch CO2 fog, with no seeming ill effect.

But, of course, DO NOT TRY THIS AT HOME.

Shouting Thomas said...

Probably the most interesting development in contemporary medicine is the use of genetic sequencing to individualize treatment.

I think that this will lead to a wholesale change in how people are treated in the future. We've been using a shotgun to aim at diseases that seem to us to be a wide range of symptoms. In the future, we'll target specific diseases much more accurately.

I just worked on a clinical trial for an Alzheimer's drug. The trial failed precisely because, I think, the theory that Alzheimer's is a single disease is probably an error. More likely, Alzheimer's is a description of a wide range of diseases, genertic predispositions, acquired disabilities, etc.

The "solution" probably isn't a single drug or a single treatment. The solution is probably individually targeted care beginning long before the onset of dementia, informed by genetic sequencing.

Inga said...

Yes, it's horrible Ann, but it's more horrible to be extremely morbidly obese. There is a network of post gastirc bypass surgery patients who do videos on YouTube, it's a support network for them. It's worth watching a few of them, not one of them regrets getting the surgery as the quality of their lives and health have improved dramatically.

Proof Weight Loss Surgery Works, is one I can think of off the top of my head. Many of these people go on to run marathons, have babies, get married, live normal lives.

Ann Althouse said...

But they only lose weight because they eat less, and they could eat less without losing their stomach!

Shouting Thomas said...

Inga, each of these surgeries costs what... well in excess of $100,000?

I know several people who've had the lap band surgery... upwards of $50,000.

I know we're not supposed to ask such questions, but... here goes...

How can we possibly afford this?

Ann Althouse said...

I know the answer is, yeah, but somehow they just can't, but I find that horrible.

Ann Althouse said...

It's like Jesus saying if your eye causes you to sin pluck it out. That's crazy!!!

Michael K said...

"Oh, my lord! What a crazy world! How horrific to remove the stomach just for weight loss"

No, the gastric bypass does not remove the stomach. It just bypasses all but a small pouch of it.

Women tend to lose weight more than men after total gastrectomy for cancer. That was actually the origin of the idea for gastric bypass. I did a total gastrectomy on a woman about 30 years ago. She weighed about 140 pounds preop. After the surgery, every time I saw her, I was afraid she had recurrence because her weight stayed about 95 pounds but she is still with us, retired to Riverside County. She still is skinny but feels fine.

Men that I have done that surgery on usually maintain their weight unless the cancer comes back.

The small intestine is hooked to the esophagus or, sometimes, a segment of colon is interposed between them.

Stomach cancer is bad news which is why I was always worried about recurrence.

Inga said...

Insurance companies are paying for these as they save hundred of thousands of dollars down the road, when the patient avoids chronic illness related to obesity, such as Diabetes, heart disease, osteoarthritis, etc. some people choose to go out of the country and self pay for their surgeries. I don't think it's as high as $100,000. But you may be right.

Shouting Thomas said...

The people who have lap band surgery ultimate have to endure numerous additional surgeries to readjust their bodies... mostly to remove excess skin, but for other reasons as well.

The ultimate bill is hard to calculate.

Inga said...

The price I just saw was $17,000 to $30,000.

Revenant said...

But they only lose weight because they eat less, and they could eat less without losing their stomach!

If it was that simple, there would be no fat people.

chickelit said...

But liquid nitrogen is like diamonds.

The Chemistry profs at UW-Madison used to do amazing demos with the stuff--like dipping a long stemmed rose into it and then shattering the flower into tiny pieces. Another trick involved driving a rubber nail into a piece of wood using a solid mercury hammer. Both the nail and the hammer (made on site from a mold) were frozen with LN2. I'm sure these things are on YouTube but you can't do them live anymore. Mercury is only for light bulbs these days.

Maguro said...

I must say I don't understand how a relatively routine procedure like gastric bypass could cost over $100K. How does the cost breakdown go, is the labor cost of the surgeon really that high?

Michael K said...

Here is a picture of the bypass.

The retail bill for everything, including hospital, might be that high but no insurance company pays retail.

That is why Blue Cross dropped UCLA Med Center from their health plan two weeks ago. It's all about negotiating discounts. Patients have no idea what the real payments are. They are commercial secrets. And hey are very large. Maybe more than 75%.

Shouting Thomas said...

Perhaps, Inga, I'm looking at NY and NJ prices, which are probably the highest in the country.

Inga said...

It depends on how obese the patient was before bariatric surgery as to the necessity for excess skin removal surgery. Also the age of the patient, the younger the patient the better their skin will snap back so to speak, especially if they weren't more than 100 pounds or so overweight. Even some of the formerly heaviest post op patients I've seen who have a great deal of hanging skin, don't opt for plastic surgery, it's a personal choice.

edutcher said...

The stroke victim for whom The Blonde was caring was nourished through a G (stomach) tube and a J (intestinal) one.

Ann Althouse said...

Many obese patients have had the Roux-En-Y....

Oh, my lord! What a crazy world! How horrific to remove the stomach just for weight loss!


The Blonde last worked a bariatric floor and all they did was banding and Roux-En-Y.

I think you have to see it as an addiction. Her best bud (the one whose sister just died) had a banding because she loved to eat (like 6 times a day) and was a great cook.

Inga said...

It most definitely is an addiction. An addiction in which one cant completely not use their substance of choice, food. And if simply eating less was a possibility they would not resort to the surgery.

Of course if these obese people would try low carb eating they would lose succesfully and some have, only to fall off the waon and regain all the lost weight and then some. It's a vicious cycle, one that bariatric surgery breaks for them.

chickelit said...

How can we possibly afford this?

We're betting the farm on preventative care tp bring costs down in the future--to get away from such expensive acute care. The emphasis should be more on people not getting that obese.

Synova said...

But if you don't keep your eating down to the tiny amounts doesn't the weight come back? So if you could somehow make yourself eat three tablespoons of food every little bit you'd lose weight without the surgery, wouldn't you?

Maybe getting the surgery allows a person to make a break from past habits and get to a place where they're maintaining instead of trying to lose but does the surgery actually change anything?

Shouting Thomas said...

Big Joe, the lead guitar player in the Old Dawgz, weighed almost 280 when I met him.

Since he retired, he's lost 120 pounds by riding his bicycle at least 30 miles a day and counting calories.

Being retired helped. He could control his diet better, and he wasn't grabbing junk food on the run.

I don't think Big Joe is a miracle worker. This can be done by just about anybody who really wants to do it.

Michael K said...

" This can be done by just about anybody who really wants to do it."

Yeah, but they tend to gain it all back. Look at Huckabee. He's gaining it back. There are liquid diets that work well for those with good will power. They still tend to gain it back. There have been studies showing morbidly obese people have something wrong with appetite suppression when they have eaten enough. They don't feel full.

ndspinelli said...

For reasons that are not yet understood, people who have bariatric surgery have their diabetes reversed IMMEDIATLY. Not after losing weight...immediately.. That is a major reason some insurance companies are covering this. They are not altruistic, they are bean counters in charge of your life.

chickelit, Our the FLOTUS is working on your suggestion.

Inga said...

Synova, the reason they can eat only a few bites is because they are no longer ravenously hungry. Also they "dump" when they eat sugar and fatty foods or eat more than a few bites. Dumping syndrome is very unpleasant from what I understand.

Many eventually are able to eat more and tolerate it after a few years time, some go on to overeating again and gain a significan amount of weigh back. Then they have a revision surgery. Not all go on to regain any significant amount and live quite normally eating small amounts.

Inga said...

Spinelli, it has to do with removal of the omentum and the hormones the omentum secretes. Maybe there is even more info on this phenomenon, haven't really looked lately.

Inga said...

Micheal K, leptin, ghrelin and insulin are whacked out, from what I've read.

jr565 said...

But they only lose weight because they eat less, and they could eat less without losing their stomach!

Easier said than done. However, in this day an age there appear to be diet supplements that cut your craving without making you actually lost most of your stomach. So it's probably redundant. Except that if you go the diet rout it's much harder.

I know someone who had the surgery, and while she still would probalby say it was worth it, I have my doubts. She's been rushed to the hospital a few times beause of bleeding ulcers that occured where she had the surgery and one time had passed out in the bathroom in a pool of her own blood and had to be driven to the hospital by her husband.

virgil xenophon said...

I knew a guy back in the 60s that, (due to what I can't remember) had his stomach replaced with a Goats' stomach and he seemed to do just fine..

Inga said...

Most bariatric surgery patients don't have severe repercussions from the surgery and report positive outcomes. Watch some of the videos on YouTube, very interesting seeing them at 300+ pounds and follow their journey through weightloss. The change is amazing and very uplifting.

Methadras said...

Ann Althouse said...

"Many obese patients have had the Roux-En-Y...."

Oh, my lord! What a crazy world! How horrific to remove the stomach just for weight loss!


It's not horrific at all. Obese people have stretched there stomachs to such an extent that they can contain and hold more food more often. That's the problem with their obesity. They never feel full and they consume more. It's a vicious circle.

Methadras said...

Ann Althouse said...

It's like Jesus saying if your eye causes you to sin pluck it out. That's crazy!!!


Even when he said it, he wasn't being literal.

chickelit said...

virgil xenophon said...
I knew a guy back in the 60s that, (due to what I can't remember) had his stomach replaced with a Goats' stomach and he seemed to do just fine..

Was he able to digest cellulose?

Julie C said...

Inga, I remember the issue of "dumping" with my father, who suffered from stomach ulcers for much of his life, and finally had a good size portion of his stomach removed way back in the 1960's. Dumping was very painful and he dealt with that for years.

Thank you for explaining it, because I never quite understood what it was before.

We treat stomach ulcers much differently now that we know what actually causes them.

chickelit said...

chickelit, Our the FLOTUS is working on your suggestion.

The task should be delegated to parents but since many kids don't have effective parents...

Inga said...

Julie, yup, H Pylori is the culprit and antibiotics is the cure( most often), that and a Proton Pump Inhibitor, which I take actually.

chickelit said...

...a Proton Pump Inhibitor, which I take actually.

Does Omeprazole have any stinky side effects? It has a sulfur at its core. I've never taken it.

Inga said...

Chickelit, nope.

Michael K said...

"She's been rushed to the hospital a few times beause of bleeding ulcers that occured where she had the surgery and one time had passed out in the bathroom in a pool of her own blood and had to be driven to the hospital by her husband."

If so, there is an error in the way the surgery has been done. Marginal ulcers occur in the Roux-Y loop and should not occur unless there is a missed gastrinoma tumor or the o is wrong.

Did the guy with the goat stomach eat boots and shoes ?

kcom said...
This comment has been removed by the author.
kcom said...

From the BBC site linked in the post above about World of Warcraft, here's one of the other headlines:

Florida man dies after roach-eating competition

So watch what you eat! Including liquid N and crawly bugs.

Methadras said...

chickelit said...

virgil xenophon said...
I knew a guy back in the 60s that, (due to what I can't remember) had his stomach replaced with a Goats' stomach and he seemed to do just fine..

Was he able to digest cellulose


I'm sure he had a terrible intolerance to haggis. :D

virgil xenophon said...

Y'all realize, of course, that I was full-well aware of what I was setting myself up for with the Goat's stomach story...but carry on, lol..

David said...

See how great Inga is when she is talking about stuff she actually knows about???!!!!

We all have our talents.

Tarzan said...

Apparently the liquid nitrogen is not just used for 'potion' effects but to freeze / frost glasses in fancy ways, quickly and such.

My heart goes out to this girl. If it happened at a frat party that might be one thing, but a college kid having fun in a bar smartly or otherwise should be able to assume the owners have some idea what the f* they're doing.

Sounds like she has spirit, though (no pun intended) and the owners of the bar are being as helpful and cooperative as they can.

Xmas said...

Aww...my friend of a friend is no longer the only liquid nitrogen ingestion survivor.

Student Gulps into Medical Literature

As my friend that witnesses what happen said, "1 centiliter of liquid nitrogen turned into 10 liters of gas. And as the upper sphincter had frozen shut, the gas had only one way to go." So I feel for this poor girl.

Jerome said...

I doubt that this girl actually swallowed any liquid nitrogen. As Xmas says, liquid nitrogen turns to gaseous nitrogen very quickly when warmed. More likely she ingested a large amount of frozen drink.

Bryan Blankenship said...

I would like to make one comment about some of the posts on here about the gastric bypass fighting "Roux-En-Y" Some of you don't have a clue.. You really don't. You think everyone that has that surgery either has cancer or are just a lard-ass trying to take the easy way out so they can pig down more food... I had this very surgery.. Only because I was a diabetic and had the damn nerves damaged in my legs from the sugar.. At that time I only weighed 215 lbs. It got to a point where I couldn't hardly walk from the nerve pains.. So the weight came on. After getting to around 325-350 lbs I wanted to do something about it before any serious health issues came up. I had the bypass surgery and it was the biggest mistake in my life and I am just 49 y/o. I had the surgery march/2013, in the first year I never could hold food down because the food never made it into my stomach.. So the first 3 months all I could eat was pudding and yogurt.. Anything soft that I knew could pass into the stomach with low problems.. Then after putting the same crap in your face you get to the point where your body rejects that.. So the next two months I decided to pass on food.. Everything I ate came back up. I have now been on the feeding tube for 6 months.. In 7 months I dropped 200 lbs and am fighting for my life.. All because my gastric bypass surgery was screwed.. I've had to have 11 surgeries this year alone... I don't have a clue any more as to what "normal" is like now.. Its now been 14 months since I've been able to eat real food.. Am I able to even eat real food any more?????? You people think that just because somebody is big its because they just love to eat.. You really have no clue...