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Thread: Gastroparesis???

  1. #1
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    Gastroparesis???

    Would somebody give me any info on Gastroparesis?

  2. #2
    Check out this site
    http://www.gicare.com/pated/ecdgs45.htm

    There were several other sites that talk about it. Quick definition is weak stomach from a variety of reasons. Did your MD tell you that you had this condition? Are you taking a GI medication like Propulsid or have a history of Gastroesophageal Reflux Disease (GERD)? PLG

  3. #3
    Jim,

    Gastroparesis is not commonly used in describing the gastric emptying problems that some people have after spinal cord injury. Slower gastric emptying has long been described in people with spinal cord injury. This problem is apparently prevalent in people with cervical spinal cord injury. It results from an imbalance of sympathetic and parasympathetic control of the gut. The rate of gastric emptying and intestinal transit times may be reduced by as much as 30-50%, taking food longer to go from swallowing to exiting the body. The effect of slower gut transit time on drug absorption varies. Halstead, et al. (1985) studied the absorption time of acetaminophen (Tylenol) in people with spinal cord injury, measuring serum drug levels after oral ingestion with and without food. There was a significant lag in the time to peak and lag times of serum drug levels in SCI subjects compared to able-bodied individuals. Segal, et al. (1986) examined theophylline in people with spinal cord injury and showed that not only is aborption delayed but the amount of drug absorbed was less than normal.

    This subject is controversial, however. Zhang, et al. (1994) from Bauman's group at Mt. Sinai in New York, claimed that spinal cord injury does not, or at least does not necessarily, affect gastric transit time. Segal, et al. (1995) studied six quadriplegic subjects and concluded that gastric transit time is significantly increased. In 1998, Lu, et al. in Oklahoma actually recorded electrical activity from the stomachs of 14 people with cervical spinal cord injury and did not find a significant difference in gastric activity, suggesting that there may be some other reason for slow intestinal transit time besides gastric activity. For example, perhaps gall bladder problems may be involved. Kao, et al., (1999) used radioactive tracers to look at gastric emptying and concluded that slow gastric emptying time occurs more frequently in females (57%) and quadriplegics (83%), compared to males (47%) and paraplegics (35%).

    Although the claim that spinal cord injury causes gastroparesis is controversial, some people with spinal cord injury do have problems with gastric emptying (Muckland, et al., 2000). Some treatments have been reported to improve gastric transit time although the problem has not been systematically studied. A drug called metoclopramide can improve gastric emptying in people with spinal cord injury (Segal, et al. 1987). Likewise, a recent study suggest that functional magnetic stimulation can facilitate gastric emptying (Lin, et al., 2002). Erythromycin lactobionate, a macrolide antibiotic, has also reported to restore gastric motility in a person with gastroparesis (Clanton, et al., 1999).

    Wise.


    • Halstead LS, Feldman S, Claus-Walker J and Patel VC (1985). Drug absorption in spinal cord injury. Arch Phys Med Rehabil. 66: 298-301. The absorption characteristics of drugs in spinal cord injury (SCI) were studied using an actively transported drug [riboflavin (RBF)] and a passively absorbed drug [acetaminophen (ACE)]. RBF absorption was studied following oral administration of 150mg RBF as 5'-phosphate flavin mononucleotide in ten clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset) and six control subjects matched for age, sex, and weight. Urinary excretion was measured under fasting (F) and nonfasting (NF) conditions for time to peak, peak excretion rate, and percent dose recovered. The results showed a significant difference (p less than 0.05) for all parameters between F and NF conditions for both the SCI and able-bodied groups. However, there was no significant difference for the same parameters between the two groups. ACE absorption was studied in five SCI clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset following the administration of a 650mg tablet. Serum samples were analyzed for ACE content and showed: time of peak, 1.35 +/- 0.6hr; maximum serum level, 6.8 +/- 2.68 micrograms/ml; half-life, 2.89 +/- 1.81hr; absorption lag time, 18.1 +/- 1.8min; area under the serum level-time curve, 21.8 +/- 6.7 micrograms/.hr/ml. When compared to able-bodied population data in the literature, there was a significant increase in the time to peak and lag time, and a decrease in the maximum ACE serum concentration obtained.(ABSTRACT TRUNCATED AT 250 WORDS).

    • Halstead LS, Feldman S, Claus-Walker J and Patel VC (1985). Drug absorption in spinal cord injury. Arch Phys Med Rehabil. 66: 298-301. The absorption characteristics of drugs in spinal cord injury (SCI) were studied using an actively transported drug [riboflavin (RBF)] and a passively absorbed drug [acetaminophen (ACE)]. RBF absorption was studied following oral administration of 150mg RBF as 5'-phosphate flavin mononucleotide in ten clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset) and six control subjects matched for age, sex, and weight. Urinary excretion was measured under fasting (F) and nonfasting (NF) conditions for time to peak, peak excretion rate, and percent dose recovered. The results showed a significant difference (p less than 0.05) for all parameters between F and NF conditions for both the SCI and able-bodied groups. However, there was no significant difference for the same parameters between the two groups. ACE absorption was studied in five SCI clinically complete quadriplegic patients (C1 to C7, two to 15 months post-onset following the administration of a 650mg tablet. Serum samples were analyzed for ACE content and showed: time of peak, 1.35 +/- 0.6hr; maximum serum level, 6.8 +/- 2.68 micrograms/ml; half-life, 2.89 +/- 1.81hr; absorption lag time, 18.1 +/- 1.8min; area under the serum level-time curve, 21.8 +/- 6.7 micrograms/.hr/ml. When compared to able-bodied population data in the literature, there was a significant increase in the time to peak and lag time, and a decrease in the maximum ACE serum concentration obtained.(ABSTRACT TRUNCATED AT 250 WORDS).

    • Segal JL, Milne N, Brunnemann SR and Lyons KP (1987). Metoclopramide-induced normalization of impaired gastric emptying in spinal cord injury. Am J Gastroenterol. 82: 1143-8. Department of Medicine, Veterans Administration Medical Center, Long Beach, California. In a partial, two-way crossover study of gastric emptying (GE) in spinal cord injury (SCI), fasted, healthy, unmedicated male volunteers were given a 99mTc-labeled liquid meal on two occasions. Metoclopramide (10 mg) was administered intravenously to each subject before the second evaluation of GE. We used single and multiexponential models with linear and nonlinear least-squares regression techniques to study the time-course of the disappearance of 99mTc from the stomach. The GE pattern in all subjects was most accurately characterized by nonlinear analysis (NONLIN) and consisted of two components, an initial adynamic phase and a phase of rapid emptying. The GE t1/2 of a liquid meal decreased from 106.6 +/- 58.3 min (mean +/- SD) in all SCI subjects (quadriplegic plus paraplegic) prior to treatment to 21.6 +/- 8.2 min after the intravenous administration of metoclopramide (p less than 0.006). Significant correlations between GE t1/2 and injury duration (yr) or level of spinal injury were observed. Impaired gastric emptying in SCI can be pharmacologically modified by metoclopramide to resemble a normal gastric emptying profile. Metoclopramide-altered gastric emptying in SCI may be expected to result in changes in the therapeutic efficacy of orally administered drugs when drug absorption is dependent on gastric motility or emptying efficiency.

    • Zhang RL, Chayes Z, Korsten MA and Bauman WA (1994). Gastric emptying rates to liquid or solid meals appear to be unaffected by spinal cord injury. Am J Gastroenterol. 89: 1856-8. Spinal Cord Damage Research Center, Mount Sinai Medical Center, New York, NY. OBJECTIVES: There is controversy with regard to the effect of spinal cord injury (SCI) on gastric emptying times of liquids. The emptying rates of solids in subjects with SCI have not yet been addressed. Thus, the gastric emptying rates for both liquids and solids were studied by radionuclide imaging in subjects with chronic SCI. METHODS: After an overnight fast, subjects with SCI were evaluated for gastric emptying rates for iso-osmolar (normal saline) and hyperosmolar (glucose) liquids and a mixed meal of liquids and solids. Twenty-five subjects received normal saline (500 ml). Of these 25 subjects, 16 and 4 others (a total of 20 subjects) received 75 g glucose dissolved in 225 ml water. Each of the liquid meals was labeled with 300 microCi technetium-99-m-diethylenetriaminepentaacetic acid (99mTc-DPTA). The mixed meal consisted of egg white labeled with 300 microCi technetium-99m-sulfur colloid (99mTc-SC) between two slices of toast with water (110 ml). Each test meal was followed by anterior radionuclide imaging of the stomach with the subject seated. The results were compared with those of matched healthy nonSCI subjects from the literature. RESULTS: Compared with gastric emptying times reported in the literature in healthy subjects without SCI, no significant differences were noted in those with SCI with regard to rates of gastric emptying for liquids (whether iso- or hyperosmolar) and for solids. CONCLUSIONS: Our findings do not support the previously reported results of a delay in gastric emptying for liquids in subjects with SCI. We have extended our findings of essentially normal rates of gastric emptying of liquids to that of solids.

    • Segal JL, Milne N and Brunnemann SR (1995). Gastric emptying is impaired in patients with spinal cord injury. Am J Gastroenterol. 90: 466-70. Nuclear Medicine Service, Department of Veterans Affairs Medical Center, Long Beach, California. OBJECTIVES: The rate and completeness of gastric emptying (GE) are major determinants of the bioavailability of oral medication, and the efficiency of gastric emptying is highly dependent on an intact central nervous system. Hence, in spinal cord injury (SCI), an impairment in gastric emptying could significantly diminish drug efficacy. METHODS: We evaluated posture-dependent (seated and supine) gastric emptying of an isotopically-labeled liquid meal in six quadriplegic subjects. The time-course profile of the gastric elimination of a radionuclide was followed for up to 120 min using serial anterior scintigraphy, and the disappearance of radioactivity from the stomach was described by both a mono- and biexponential fit of raw data. A half-time of gastric emptying (GEt1/2) was estimated from each curve and compared to GEt1/2 derived from able-bodied (intact neuraxis) experimental and historic control populations. RESULTS: The mean GEt1/2 in quadriplegic subjects (monoexponential curve fit) was significantly increased to 43.4 +/- 26.0 min in seated SCI subjects (95% CI 13.5-73.2, p < 0.05) and to 50.5 +/- 48.0 min in supine SCI subjects compared to supine experimental and historic control values of 10.1 +/- 8.8 min [95% CI 2.3-18.0, p < 0.05) or 12.0 +/- 3.0 min [95% CI 9.4-14.8, p < 0.05), respectively. A small, non-significant trend towards an increased rate of GE [decreased GEt1/2) was observed in seated SCI subjects. CONCLUSIONS: We conclude that gastric emptying is impaired in subjects with cervical SCI. Comparative studies of gastric emptying in subjects with SCI should incorporate concurrently studied, control subjects and employ experimental methods that are not constrained by truncated data collection periods. The convention of forcing GE data to conform to a monoexponential pattern of evacuation ignores time-dependent multiphasic patterns of GE and does not support serendipity.

    • Segal JL, Milne N and Brunnemann SR (1995). Gastric emptying is impaired in patients with spinal cord injury. Am J Gastroenterol. 90: 466-70. Nuclear Medicine Service, Department of Veterans Affairs Medical Center, Long Beach, California. OBJECTIVES: The rate and completeness of gastric emptying (GE) are major determinants of the bioavailability of oral medication, and the efficiency of gastric emptying is highly dependent on an intact central nervous system. Hence, in spinal cord injury (SCI), an impairment in gastric emptying could significantly diminish drug efficacy. METHODS: We evaluated posture-dependent (seated and supine) gastric emptying of an isotopically-labeled liquid meal in six quadriplegic subjects. The time-course profile of the gastric elimination of a radionuclide was followed for up to 120 min using serial anterior scintigraphy, and the disappearance of radioactivity from the stomach was described by both a mono- and biexponential fit of raw data. A half-time of gastric emptying (GEt1/2) was estimated from each curve and compared to GEt1/2 derived from able-bodied (intact neuraxis) experimental and historic control populations. RESULTS: The mean GEt1/2 in quadriplegic subjects (monoexponential curve fit) was significantly increased to 43.4 +/- 26.0 min in seated SCI subjects (95% CI 13.5-73.2, p < 0.05) and to 50.5 +/- 48.0 min in supine SCI subjects compared to supine experimental and historic control values of 10.1 +/- 8.8 min [95% CI 2.3-18.0, p < 0.05) or 12.0 +/- 3.0 min [95% CI 9.4-14.8, p < 0.05), respectively. A small, non-significant trend towards an increased rate of GE [decreased GEt1/2) was observed in seated SCI subjects. CONCLUSIONS: We conclude that gastric emptying is impaired in subjects with cervical SCI. Comparative studies of gastric emptying in subjects with SCI should incorporate concurrently studied, control subjects and employ experimental methods that are not constrained by truncated data collection periods. The convention of forcing GE data to conform to a monoexponential pattern of evacuation ignores time-dependent multiphasic patterns of GE and does not support serendipity.

    • Segal JL, Milne N and Brunnemann SR (1995). Gastric emptying is impaired in patients with spinal cord injury. Am J Gastroenterol. 90: 466-70. Nuclear Medicine Service, Department of Veterans Affairs Medical Center, Long Beach, California. OBJECTIVES: The rate and completeness of gastric emptying (GE) are major determinants of the bioavailability of oral medication, and the efficiency of gastric emptying is highly dependent on an intact central nervous system. Hence, in spinal cord injury (SCI), an impairment in gastric emptying could significantly diminish drug efficacy. METHODS: We evaluated posture-dependent (seated and supine) gastric emptying of an isotopically-labeled liquid meal in six quadriplegic subjects. The time-course profile of the gastric elimination of a radionuclide was followed for up to 120 min using serial anterior scintigraphy, and the disappearance of radioactivity from the stomach was described by both a mono- and biexponential fit of raw data. A half-time of gastric emptying (GEt1/2) was estimated from each curve and compared to GEt1/2 derived from able-bodied (intact neuraxis) experimental and historic control populations. RESULTS: The mean GEt1/2 in quadriplegic subjects (monoexponential curve fit) was significantly increased to 43.4 +/- 26.0 min in seated SCI subjects (95% CI 13.5-73.2, p < 0.05) and to 50.5 +/- 48.0 min in supine SCI subjects compared to supine experimental and historic control values of 10.1 +/- 8.8 min [95% CI 2.3-18.0, p < 0.05) or 12.0 +/- 3.0 min [95% CI 9.4-14.8, p < 0.05), respectively. A small, non-significant trend towards an increased rate of GE [decreased GEt1/2) was observed in seated SCI subjects. CONCLUSIONS: We conclude that gastric emptying is impaired in subjects with cervical SCI. Comparative studies of gastric emptying in subjects with SCI should incorporate concurrently studied, control subjects and employ experimental methods that are not constrained by truncated data collection periods. The convention of forcing GE data to conform to a monoexponential pattern of evacuation ignores time-dependent multiphasic patterns of GE and does not support serendipity.

    • Kao CH, Ho YJ, Changlai SP and Ding HJ (1999). Gastric emptying in spinal cord injury patients. Dig Dis Sci. 44: 1512-5. Department of Nuclear Medicine, Taichung Veterans General Hospital, Taiwan. Prolonged gastric emptying half-time (GET1/2) has been observed in several neurological disorders. However, findings of altered gastric emptying (GE) in previous studies on subjects with spinal cord injuries (SCI) have been questioned. Thus, GET1/2 of solid meals in SCI patients was studied by radionuclide imaging. This prospective study was conducted to assess GET1/2 in 50 SCI patients using radionuclide labeled solid meals. GET1/2 was abnormal in 58% of the 50 SCI patients. Age (abnormal GET1/2 in 57% of young vs 59% of old patients) and injury duration (abnormal GET1/2 in 61% of long vs 56% of short duration patients) were not statistically significant factors influencing GET1/2 (P > 0.05). However, the incidences of abnormal GET1/2 in female SCI patients (57%) and patients with high level injury (quadriplegic) (83%) were higher than in male SCI patients (47%) and patients with low level injury (paraplegic) (35%) (P < 0.05). SCI can cause significant prolonged GE of a solid meal, especially in female patients and patients with high level injury.

    • Mukand JA, Kaplan MS, Blackinton DD, Biener-Bergman S and Trojan DA (2000). The gastric emptying scan as a tool for surgical management of severe bowel dysfunction in spinal cord injury: 2 case reports. Arch Phys Med Rehabil. 81: 1531-4. Southern NE Rehabilitation Center, Providence, RI 02907, USA. We describe 2 patients with spinal cord injury (SCI) for whom the gastric emptying scan (GES) was crucial for determining the correct surgical approach in the therapeutic management of gastrointestinal complaints. Two men, ages 45 and 51 years, were admitted to a university hospital for delayed gastric complications from SCI. Both SCIs were traumatic, and the interval since injury was 18 months for the younger man and 6 months for the older man. Both men lacked voluntary motor and sensory function below the cord level of the lesion and had quadriplegia. Using GES, we measured motility (the cutoff for normal in this laboratory is 37%) and the time at which half the gastric contents were emptied (normal values are 45 +/- 8 min). Both patients had abnormal motility: residuals at 1 hour were above 50%. Half the gastric contents were emptied at 75 and 90 minutes, respectively. The therapeutic value of the GES was demonstrated for both patients, in combination with the history, physical examination, and abdominal radiographic studies. The first patient underwent ileostomy, and the second required a gastrostomy tube and a jejunostomy tube in addition to metoclopramide. The GES is a valuable diagnostic tool with an important role in the surgical management of patients with SCI.

    • Mukand JA, Kaplan MS, Blackinton DD, Biener-Bergman S and Trojan DA (2000). The gastric emptying scan as a tool for surgical management of severe bowel dysfunction in spinal cord injury: 2 case reports. Arch Phys Med Rehabil. 81: 1531-4. Southern NE Rehabilitation Center, Providence, RI 02907, USA. We describe 2 patients with spinal cord injury (SCI) for whom the gastric emptying scan (GES) was crucial for determining the correct surgical approach in the therapeutic management of gastrointestinal complaints. Two men, ages 45 and 51 years, were admitted to a university hospital for delayed gastric complications from SCI. Both SCIs were traumatic, and the interval since injury was 18 months for the younger man and 6 months for the older man. Both men lacked voluntary motor and sensory function below the cord level of the lesion and had quadriplegia. Using GES, we measured motility (the cutoff for normal in this laboratory is 37%) and the time at which half the gastric contents were emptied (normal values are 45 +/- 8 min). Both patients had abnormal motility: residuals at 1 hour were above 50%. Half the gastric contents were emptied at 75 and 90 minutes, respectively. The therapeutic value of the GES was demonstrated for both patients, in combination with the history, physical examination, and abdominal radiographic studies. The first patient underwent ileostomy, and the second required a gastrostomy tube and a jejunostomy tube in addition to metoclopramide. The GES is a valuable diagnostic tool with an important role in the surgical management of patients with SCI.

    • Lin VW, Kim KH, Hsiao I and Brown W (2002). Functional magnetic stimulation facilitates gastric emptying. Arch Phys Med Rehabil. 83: 806-10. Functional Magnetic Stimulation Laboratory, Spinal Cord Injury/Disorder Health Care Group, VA Long Beach Health Care System, Long Beach, CA 90822, USA. vernon.lin@med.va.gov. OBJECTIVE: To evaluate the effect of functional magnetic stimulation (FMS) on gastric emptying in able-bodied and spinal cord injury (SCI) subjects. DESIGN: A prospective, nonrandomized clinical experiment. SETTING: SCI and disorder center in a Veterans Affairs medical facility. PARTICIPANTS: Five healthy, able-bodied subjects and 4 subjects with SCI. INTERVENTION: A commercially available magnetic stimulator was used; a round magnetic coil was placed along the T9 spinous process. The intensity of the magnetic stimulation was 60%, with a frequency of 20 Hz, and a burst length of 2 seconds for the gastric emptying protocol. Man Outcome Measures: Rate of gastric emptying and time required to reach gastric emptying half-time (GE(t1/2)) with and without FMS. Data fit into linear regression curve. RESULTS: Accelerated gastric emptying was achieved in both able-bodied and SCI subjects. The mean +/- standard error of mean of the GE(t1/2) at baseline and with FMS was 36+/-2.9 minutes and 33+/-3.1 minutes, respectively, for able-bodied subjects, and 84+/-11.1 minutes and 59+/-12.7 minutes, respectively, for SCI subjects. CONCLUSION: Gastric emptying was enhanced by FMS in able-bodied subjects and was greatly enhanced in SCI subjects. FMS can be a useful noninvasive therapeutic tool to facilitate gastric emptying in humans.

    • Clanton LJ, Jr. and Bender J (1999). Refractory spinal cord injury induced gastroparesis: resolution with erythromycin lactobionate, a case report. J Spinal Cord Med. 22: 236-8. Department of Physical Medicine and Rehabilitation, Methodist Medical Center at Dallas, Texas, USA. Erythromycin lactobionate (ERY), a macrolide antibiotic, has been the focus of investigation as a new gastrointestinal prokinetic agent. In individuals who are able-bodied (AB), ERY has shown promise in various forms of gastroparesis (GP). Recent evidence suggests that medications used to stimulate intestinal motility in individuals who are AB have had similar results in those individuals with spinal cord injury (SCI). Medications that have been used in the past for GP in SCI include metaclopramide, neostigmine, and bethanechol. In this observation, a patient with T-6 paraplegia, who developed GP secondary to acute SCI, is presented. During his hospital stay, the patient was treated with gastric decompression, bowel rest, H2 blockers, intravenous metaclopramide, and eventually required parenteral nutritional support. ERY was started and symptoms abated. At this point, the nasogastric tube was removed and oral feeding was successfully started. This case report is the first to describe a patient with refractory SCI-induced GP who responded to intravenous ERY. Further study in this area is warranted.

  4. #4
    Senior Member SurfCat's Avatar
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    Wow, this sounds exactly like what I've been suffering from for 2 plus years!

    I wonder if this it...the answer I've looked under every rock to find?

    Why would the pain be at it's worst in the early mornings...just awful?

    Thank You!

  5. #5
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    My doctor hasn't said I have it, I'm not taking any medications for gastroparesis and don't have any history of any acid reflux decease. I'm just trying to figure out my stomach discomfort. They can't figure it out here at Iowa Veterans Home.

  6. #6
    SurfCat,

    One of the important considerations that nobody has mentioned so far is the effects of drugs on stomach activity. It is entirely possible that a lot of gastric symptoms that people describe after spinal cord injury can be a byproduct of drugs that they are taking to counter muscle and bladder spasticity. For example, bladder anti-spasticity drugs are anti-cholinergics. These drugs significantly reduce gastric secretion (they reduce saliva flow, for example). They are very likely to have a deleterious impact on digestion and gastric activity.

    Wise.

  7. #7
    Senior Member SurfCat's Avatar
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    Wise, as you know (I'm a.k.a. Patrick Steele :-) I have severe chronic pain for which I'm on high doses of OxyContin amongst regular doses of baclofen and low doses of anti-depressants also for pain control.

    Do you believe these would have a severe impact on gastroparesis especially if I'm already inclined? Thanks for pointing this out.

    Any successful treatment ideas you know of?

    Thanks. You are amazing to me. Patrick

  8. #8
    patrick, opioids cause constipation and have significant effects on gastric emptying. Wise.

  9. #9
    True gastroparesis is different that the constipation resulting from narcotic use. The former is a neurologic problem due to lack of parasympathic innervation to the gut, and rarely gets better. Constipation due to narcotic use is a temporary problem that gets better generally when narcotics are discontinued or decreased.

    (KLD)

  10. #10

    Smile gastroparesis

    i've been reading your blogs and i'm new to this site. i don't have a spinal injury but have been diagnosed with gastroparesis after a gastric dump study. i do not have any known cause for this but do have seizures and other medical problems, including stomach problems and take several medication including two seizure meds. i have had several episodes where i get "flare ups" after rounds of antibiotics or steriods and go for several months of not being able to eat. this can range from only nausea with foods to vomiting and after 2 to 3 months of liquid nutritional drinks (boost) i can start eating again.
    i had to take an antibiotic in november 07 and it irritated my stomach and i have not been able to eat since then without getting nauseated. i have lost over 20 pounds and weigh 110. my doctor wants to put a feeding tube in now but will give me to 100 lbs. i wanted to know if anyone has had a tube put in and how they faired with it and what limitations, if any, they had.

    tks

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