Tuesday, April 30, 2013

A Truckload of Info on Dumping

Photo by M Clock, on location

Names can be deceiving.  So can words, and I guess names qualify as words.

Take Dawn for example.  I was down in Florida this Spring and I was at the hotel pool for some vitamin D and a quick chlorinated swim.  I had to take a second look at the sign that was there in plain view.

I believe it said in the event of an emergency to call DAWN DUSK.  I did not know who she was, what her role was, or how to get hold of her.  I bet if I went to the front desk, I suspect they may have called for security if I pressed the issue.  You don't really want a lot of confusion if there's an emergency going down...

OK, I'll let it go.

Similar example with "Dumping Syndrome." When I ask patients in the office if they "dump", they are often quick to recall a forbidden food item they either ate too fast, or too much at one time, and then vomited.

That's not dumping...that's called "Behavioral Indiscretion".

Which finally allows me to get to my point of discussion for today's blog post - Dumping Syndrome.

As you are probably aware, Dumping Syndrome is fairly common after Gastric Bypass, as well as other gastric operations that involve bypassing or removing the pylorus, which regulates the passage of food into the small intestine.  In effect, the ingested food bypasses the stomach too rapidly, and as a result, the hyperosmolar chyme enters the small intestine quickly, resulting in fluid shifts and autonomic nervous system activation.

The common symptoms of Dumping Syndrome are based on when they occur, "Early" and "Late."

Early Dumping occurs very soon after meal ingestion, and causes nausea, vomiting, bloating, cramping, dizziness and fatigue.

Late Dumping, usually within 1-3 hours after eating, is manifested by weakness, sweating, and dizziness.

I had an interesting case recently where a patient was about to 'require' a pacemaker as she had experienced a few episodes of dizziness and sweating and near syncope.  She had a Holter report showing significant bradycardia associated with her symptoms of dizziness and diaphoresis, and it seemed logical she would need a pacer.

This 38 y/o was sent to see us to ascertain whether or not there was any contribution to her complaints due to her bypass.  Labs, including CBC electrolytes were within normal, and I spoke with her cardiologist about the possibility of Dumping Syndrome (as opposed to hypoglycemia - her home BG's were normal ) He was truly hopeful that she could be managed medically without the pacer, an intervention that was likely not going to truly fix the issue with her increased vagal tone, and her secondary bradycardia.

And, more than likely, the most efficacious treatment necessary for those that "Dump?" (Kind of like when someone asks you what to do when they point to a body part and say, "It hurts when I do this".  Answer:  Don't do that.)

It's behavioral!

Eliminate simple sugars from the diet, or other foods that may have triggered an episode.  And, no drinking within 1.5 - 2 hours after eating as not to 'rinse' the food down into the jejunum (Roux limb) too quickly. These interventions are often a big help, and minimize or eliminate complaints in the future.





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