Starting Stage Five soon - what's better and not so good?

If you want to know how far out I am -- it doesn't matter. We all follow the timetables set by our own surgeons. The important part is that I will soon be entering the last stage, moving from "soft foods only" to "whatever your body can handle". And I need suggestions about what order to go in.

Just as an example of something that I found out by accident: When I was talking to my surgeon about scheduling, and it looked like the surgery might be in the early spring, I said to him, "I really want to be able to eat at least a few bites of matzah on Passover, so I'd like to schedule it either so that I've healed enough by then, or let's schedule it for after Passover." His answer was very surprising: "Actually, your pouch can handle crackers long before it can handle regular bread. Bread is all doughy and can clog up the stoma, but crackers just crumble and usually aren't a problem."

That really surprised me, and I'm hoping that other people can give similar suggestions. For example:

VEGETABLES: I understand that crumbly stuff like potatos and carrots are easy, but stringy ones like celery should wait. What else is very stringy? Asparagus, green beans, lettuce? Any problem with the meatiness of a big beefsteak tomato?

FRUITS: I remember hearing that the sections of an orange or grapefruit are fine, but to stay away from the fibrous junk that separates them. What about apples and pears? I vaguely remember something about the skin, but I don't remember what it was.

MEAT: My guess is that all meats are the same, and the main differences are in how they're prepared and chewed: Ground is great, for example. I would have thought well-done is better than rare, because it is crumbly, but I think I've heard otherwise.

GRAINS: As I said, my surgeon said crackers are better tolerated than soft breads, and I suppose that cookies and toast are similar to crackers. Of course, this is a separate question than the importance of going easy on the refined carbs, but I'm really itching for something to slather my cheese onto. (I'd eat some peanut butter too, but not by the spoonful.) A high-protein breakfast cereal should be in the cracker category too, right? What about pasta? I'm guessing that it's even worse than bread. (Hey, pasta=paste, right?) Rice and quinoa anyone?

DAIRY: All the soft and hard cheeses and yogurts are already okay, so I can't think of anything to ask in that regard.

Well, everyone rules on how to eat differ.  It really is more based on what your body can tolerate.  Me, I can not STAND fats in large amounts.  I mean I can do it and I like them, but if I eat too much I have a bad stomach ache, so I have had to learn to eat very low fat and if I do eat fats that are higher in fat, limit them.  Like when I eat salad, I put the dressing on the side and dip the stuff in it very lightly.

The skin of fruit, like grapes, might be a problem.  Never has been for me.  Start with chicken and fish, wait a bit and add beef.  Some people take meat fine, others have issues.

Here is a good rule.  Whenever you try "something new" do it at home.  Do not go out and try a new food unless you want to waste the rest of that time in pain or running to the bathroom. Only eat foods that you can tolerate and you know that for a fact when you are out.  Also, let's say you eat at 12 noon, don't eat again for at least 2 hours.  This will keep you from grazing.

Last, limit your carbs.  Fruit and dairy have carbs as does bread and grains. Limit them as much as possible.  Protein first.  

Good luck! 

I'd say you have to let your pouch be your guide..we're all a little different.
Generally speaking, meats are the most difficult- chicken often the worst-
and should be very moist. I could not tolerate chicken until I was at least
6 months out and I still, at a year out, do ground meats.  Again generally,
rice, white potatoes and doughy breads and pastas don't do well in
our pouches, but you may find that you can eat some or all of those.
I use couscous and quinoa instead of rice in dishes that call for them.
I have never had any issues with vegetables unless I tried to eat too
much raw veggies like carrots.......but I can eat quite a large salad
for example with no problems. Fruits....not an issue, but you will want
to start slowly to make sure you don't have problems with dumping
on the fruit sugar.

Mostly, start slowly. I did a lot of mushy foods until I was about 6 months
out as my pouch didn't do well with anything else.  Honestly, I still feel better
with mushy foods, although I cook and eat just about everything except
the "white" foods.  If something doesn't work, wait a few weeks and try
it again.  Your tolerance and taste will continue to change.  You will of
course need to keep chewing everything to mush before you swallow
so I didn't have an issue with stringy veggies.

Good luck!

You may not find this answer very helpful, but everyone is different with regard to what they tolerate.  I would try a few whole grain crackers or half a slice of whole grain toast before trying soft bread or pasta.  But some people, like me, tolerate soft bread just fine.  Always have.  Pasta feels kinda heavy in my pouch, though.  I can eat it, but just in small amounts and it doesn't feel so great.

Some people feel skins of things like apples are hard to digest but they've never bothered me.

I don't eat meat, but I hear people say often that it has to be really moist for them to get it down.

It's gonna be trial and error.  I suggest only trying new foods at home, because getting sick in a restaurant sucks.  Who wants to puke in a restaurant toilet?  Yeah, it's gross.  I know from experience.  Also only try a small amount of a new food at a time.  That way if it doesn't agree with you, your discomfort or sickness will be less than if you eat as much of it as you possibly can.

Fruits and Veggies don't really bother me as long as they chewed well. In terms of grains/carbs I stick with crackers with very good stats ( e.g. Trader Joes Savory Thins), Quinia, Sweet Potato.

Now in terms of Passover (or Pesach as we call it),I can speak from last years experience. I too wanted to eat the requisite amount as well as drink the four cups in some form. I had surgery Februaury 14th of last year so I was not as far out as you will be. However I can tel you that after discussing it with a Rabbi and figuring out the minimum amount to try I made myself very sick the first night and was not able to make and attempt the second night. Matza is very dense and heavy and even though most foods are not an issue now dense crackers such as WASA crisps (I haven't tried Matza again) do not work. They get "stuck" and cause me to have "foamies" and even vomit.
If you want to I can discuss this matter further with you in PM or email [email protected].

I first started with the solid version of stuff I had on pureed. For example, I made crock pot chicken with onions and carrots and chicken breast, cooked with a can of reduced fat cream of mushroom and chicken broth pureed. One of my first meals was this not pureed. Same with meat sauce. 

I have no problems with meats (can eat and have tried beef, pork, chicken, shrimp, etc.) So once I new I could try them in some form, I experimented a bit. Using different combinations of things I knew were okay with me in different combinations and adding one new ingredient each day. My clinic suggested this as if I had a problem with something later in the day, whether right after the meal or later, it would mostly like be do to the new item and I could adjust as necessary. I was also told to try things at leat three times (separated over a few weeks) to see if it truly doesn't agree with me or if it was something with the way I ate the food/prepared it/etc. I've had times when both beef and pork didn't agree with me and found that it was often due to the type of cut used (too much fat marbling) that caused me discomfort. I find that leaner meats work best. This also works for me because I've never been a fan of fatty meat and try to avoid it, but now try to be extra dilligent.

I tried softer things, like chicken breast slow cooked in sauce, before trying bbq'ed or baked chicken breast, because I was told to merge from soft solids to whatever I wanted within the guideline of my clinic at my own pace. It didn't take too long and I now enjoy a wide variety of healthly, protein forward meals and menus. 

As for breads, I didn't try bread until I was comfortable with other foods first. My clinic suggested when moving to the menu for life that I try things that I knew I would be comfortable with, based on having them in pureed forms, then adding in various cooked fruits and veggies, then trying raw fruits and veggies (apples, pears, etc. must be peeled for easier digestion) and salads, then red lean meats, final pastas and breads. When I did have pasta and bread, I choose low carb, high protein versions. I found the pasta was fine with a bit of sauce, but the bread was better toasted and with the crusts removed. Try everythin though in different ways and see how you like it and how it agrees with you.

Hope these ideas help, good luck!

I seem to have a pouch of steel and haven't had issues with much of anything (knock on wood!). That said, apple peels didn't settle well - I can eat apples without peels just fine - for some reason I don't think I can chew the peels enough to make it work. The other thing is thick/doughy bread (like breadsticks). I've had ciabatta bread without too much issue, but I felt full for HOURS, which was a nice change, but it really wasn't worth the calories, so I've not had it again.

My only carb go-to these days are the high fiber/low carb tortillas from La Tortilla factory. They can have things slathered on them and then filled with lunch meat and cheese. At two months I can eat a half of a wrap or one of the small tortilla size ones without an issue.
And I've eaten a lot of green beans lately because I love them I did raw carrots without an issue too. But that's all I've tried.

Good luck with your new food stage! The freedom is nice

Thank you all for the ideas!

The consensus seems to be everything is worth trying, and there's no telling what will be better or not so good. The only exception seems to be the starches, which EVERYONE (or so it seems) is universally afraid of, and waits many months until trying them.

When I was writing that last paragraph, I was looking for a nice generic word which would include rice, potatoes, breads, crackers, and pastas. My first thought was "grains", but that didn't include potato, and that's how I came to the word "starch".

But that raises an interesting question in my mind: Isn't oatmeal, farina, and cream of wheat in this very same category? What makes them so digestible that many of us ate them as soon as we got home from the hospital? If your answer is that they're cooked instead of baked, then what about pasta?

Please understand that I am NOT challenging anyone. I just want to understand the patterns, so that I can apply the logic to other foods on my own.

A few people suggested not to start anything new away from home, just in case of a bad reaction, and I had already thought of that on my own. But the idea of trying the same food mushy first and then solid - that never occurred to me, and I thank those who suggested it. So, along those lines ---

Would bread pudding, or stuffing, be a reasonable way of easing into bread?

How about breaded items? I don't mean breaded fish sticks or fried chicken, which are way too crispy and dry in any case, but what about the breaded eggplant in an eggplant parmigiana? That's certainly mushy enough, no? Or, if you think that breading to be too light to be a problem, then I'll ask about my wife's breaded chicken cutlet, which has a really thick and delicious breading, soaking in an unbelievable sauce. There's no moister chicken in the world!

The fruits vegetables that my surgeon, who has her patients start on soft foods day 3, warned us to hold off on until 2 or 3 months post-op are the very fibrous, hard to digest ones such as broccoli, cauliflower, pineapple, celery, the citrus fruits other than mandarin oranges (which are "peeled"), etc.  I can tolerate all but 4 foods, but the membrane surrounding orange/tangerine/grapefruit segments is one of them... and I am 4.5 years out!  The skin of SOME apples bothers me, but with some others (and with pears) it is fine.

Sometimes people tolerate cooked veggies better than raw ones.  I can eat cooked carrots with  o restrictions, but raw carrots on an otherwise empty stomach makes me queasy.

The biggest consideration with beef, pork, amd poultry is how well you can chew it into a mushy consistency.  Although it sounds backwards, a strip steak or filet mignon cooked medium chews up much more easily than well-done ground beef.  I no longer eat ground beef (just ground sirloin) or pork roast or chops because they are simply too hard to chew adequately (and I find that the flavor changes in an unpleasant way the longer you have to chew it!)

Lora

Bread pudding and stuffing would work likely, but what you will focus on
for a long time is protein, protein, protein. If you are able to only eat a few
ounces to start, it needs to be protein-based. Then have bites of veggie,
fruit or grains/carbs. I'm a year out and I can eat about a cup of food- so
I make sure that anything I eat has at least 10-15 grams of protein source
in it. The short answer is really that nothing is off limit, but once the surgery
has done its work and you hit your maximum, you will have to do the hard
work to keep the weight off.  For me certainly, that means I think about what
got me here and what my body needs vs. what my cravings or "head" thinks
I need. For that reason, I keep my eyes on carbs that are not veggies and
avoid them as much as is reasonable. I have done that hard work since
I got home from the hospital...better to avoid empty foods than to have to
wean off them later.  For you, maybe that's not so much an issue.
Since I don't do well with pasta or rice, for example, I do use quinoa
and couscous.  When I want toast with peanut butter for breakfast, I
use a full grain bread that is 75 calories a slice (small, thin slices) and
I have only 1.  Since it's very grainy and full of fiber, it goes down well
and isn't doughy. I'd say you're asking the right questions, and with some
experimentation you'll find what works best for you.  Good luck!