Never Had Surgery? Here's What to Expect!

Discussion in 'Main Forum' started by Elizabeth N., Jan 1, 2014.

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    Elizabeth N.

    Elizabeth N. Herder of cats

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    The purpose of this thread is to address the expectations of people who have never had abdominal surgery with general anesthesia. It's not specific to any WLS procedure, just to the experience of surgery. My reason for this thread is that I keep reading really ridiculous posts from people who are like 24-48 hours postop who think they should be back to normal and see evidence of weight loss on the scale and in the mirror.

    Um, NOT realistic. I would like to think that the hospital and surgeon people would educate folks on this stuff, but I know they don't. So, let's educate please.

    Would people please chime in here and tell about what happens the morning of surgery when you check in and get prepped? My experience was a little different from the usual because of my severe medical situation at the time, so I don't want folks to go by my details on this. Bascially: You'll show up at the hospital, sign lots of papers, change into surgical attire, get blood drawn, IV port started, fast interviews with several medical people, and get herded into the waiting line for your OR room/team. Chances are you will have to say goodbye to the people who accompanied you to the hospital and then still hang out on your gurney and wait for a while.

    At this time, if you want happy juice so you remember nothing, you will have mentioned this to anesthesia people at your preop evaluation, but you can still ask for it now if you start to freak. Do NOT lie there on your conveyance and just endure fear/panic/misery. SPEAK UP.

    You will either be wheeled or asked to walk to the operating room. Some people find walking into the OR to be pretty wild. Control freaks like me think it's great LOL. I don't want to give up any control I don't have to until the last second! If you get happy drugs they'll wheel you in cuz you'll be too stoned to maneuver.

    You MIGHT remember some of this: In the OR you will be asked once again your identifying info (compared to your bracelet and their written stuff), what kind of procedure you're having and that you consent to this whole spiel. You'll get on the table, which will be cold and uncomfortable. At this time, THINK about what will help you to lie there paralyzed for hours with a minimum of misery. Do you have a bad knee/back/hip/shoulder/elbow/neck? SAY SO. Insist on getting your bad joint supported with pillows or towels or whatever, cuz you're gonna be there a long time and you will not automatically change your position like you do when you're asleep.

    If you have limited range of motion somewhere, like your neck, demonstrate your range of motion to Anesthesia Dude and say in plain English what the limits are. They will listen and try to accomodate. They LOVE IT when people tell them stuff that will help them make you less miserable later.

    Somebody will stay at your head and talk to you and say goodnight. You might remember getting a mask on your face and being told to breathe deeply and relax. You might feel suddenly drugged/dozy for a moment. The next thing you will know--and it will seem like no time has passed and that loss of time will be a little weird--someone will be shaking you awake and telling you it's over. (You will very likely not remember any of this either, especially if you had happy juice.)

    You can use Google to find a total demonstration of everything that happens in your surgery with as much live or cartoon detail as you want. I will skip those details except to say in general: The general anesthesia involves drugs that render you unconscious, paralyzed, devoid of sensation and amnesic. Look up general anesthesia for more information if you want it. The anesthesia team will do EVERYTHING for you except run your heart and your brain, basically. Anything the paralytic drugs stop, they do, like breathe for you. This is why you must be intubated and have a catheter during surgery.

    You will NEVER receive as much focused, professional, carefully, absolute attention in your life as you do when you are under anesthesia. It's just about the safest place on the planet to be. You are at greater risk of being hit by a car than you are of dying under anesthesia. Probably the risk is higher of your house collapsing on you than of dying from anesthesia, but I haven't actually SEEN those stats lol.

    Once your surgery and anesthesia are over, you will be wheeled from the OR to the PACU, post anesthesia recovery unit. There you will be lovingly attended by your very own PACU person and a hell of a lot of equipment. Various people will be bugging you about how you feel, telling you to breathe, asking you your pain level, having you move your feet, etc. You will have pressure cuffs around your lower legs and these will inflate/deflate. You might be damned cold. This is cuz the OR is about icebox temperature, and because of the effects of anesthesia. COMPLAIN....about ANYTHING that bugs you. Trust me, your complaints give the folks valuable info and they can and will help you. This is NOT the time to be brave and suck it up. This is whining time.

    If you are happy as a clam and higher than a kite, SAY SO. This is also valuable information.

    By all means tell everyone your life's story, that you love them, that you will make them filet mignon, have their baby, whatever. They LOVE hearing you talk. It's good for your breathing and it entertains them.

    Oh BTW everyone in the world will be bugging you to BREATHE and COUGH and it will suck because your belly got blasted. THAT you must suck up. Your one major task in life right then is to breathe deeply and often. If it hurts too much to breathe, whine loudly, but BREATHE while doing it. REMEMBER THIS,. do you hear me? DEEP BREATHING IS IMPERATIVE. You gotta get the anesthesia out of your person, you gotta get the crap out of your lungs, you need the oxygen.....BREATHE BREATHE BREATHE. Trust me, you do NOT want post anesthesia pneumonia. Look it up on Google, get scared and BREATHE.

    After a while in PACU, you will get removed to your room. IMNSHO remembering this (which I do, from multiple surgeries) is a bummer, because it involves moving and getting bumped even by the most careful of orderlies. Motion on post anesthesia belly is nauseating. Getting bumped with slashed belly hurts. Close your eyes, take a shot of your pain meds if you have a pain button and try to go unconscious for this. Use brain power to black out for this ride if possible.

    You'll arrive in your room. Depending on how your surgery went and how stoned you are, you will either sit up and step from gurney to bed or you will be transferred by personnell. Both methods suck but for different reasons. I cannot recommend a preference.

    Your bed will be fucking cold. New people will arrive. There will be lights and noise and annoyance. You might welcome or resent the activity, and you may or may not remember any of it. Follow instructions, whatever they might be, with all the zest you can muster, for obeying your instructions will lead to going home sooner AND to feeling better faster, even though you might not be able to imagine it at that point.

    For me, my instructions were to lie there and shut up, basically. Okay, not really, but I was in ICU and had major medical shit going on and nobody knew what I could do for myself because I came in to the hospital on oxygen and barely walking. So I got treated as sicker than I really was and it was a miserable experience. Most of you will be dragged out of bed and told to walk, pee, etc. DO IT. Yes it will hurt and yes you will be cranky. DO IT ANYWAY. It's good for you.

    Depending on your procedure, surgeon, medical condition and protocol, you might wake up with: a catheter between your legs, NG tube in your nose, oxygen in your nose, drains in your belly, peg tube aka feeding tube in your belly. You WILL have some kind of IV port going, could be a basic vein in arm, a port in upper arm, chest or a central line in your neck.

    (Central lines are da bomb. You can get an eggplant sent through those suckers and you'd never know. Do not resist a central line. They get put in when you're out and held in place, usually in your neck, by one or two stitches. The scars are miniscule but resemble vampire bites, so they are cool looking. Central lines free up your arms and you don't get bruised to hell because they go in deeper veins.)

    Regarding the tubes: Chill. They are your friends. The catheter means you don't have to haul your miserably sore ass out of bed immediately for two tablespoons of pee--and trust me, with all the fluids they are pumping into you, you will have LOTS OF PEE.

    Catheter removal for women feels like removing a very soaked/lubed tampon. Sorry guys, dunno what it's like for you.
    Belly drains: Also your friend. They get fluids out of your surgically traumatized gut that would otherwise hang out and hurt and maybe cause infection. Ignore them unless you have to go home with them. Then treat them as your friends and follow your care instructions. Really, they are no biggie if you expect them and just do what you have to do.

    Jtube/feeding tube: The way to not get back in the ER with dehydration from hell. LOVELY invention. USE IT to make sure you get tons of fluids, your protein drink, etc. Be glad it is there and use it to get stuff in that will help you heal faster. When drains and J tube come out it will be WEIRD but only minimally uncomfortable unless they stick to your skin. Then they will pull and hurt a bit. It's okay. They are your friends. Attitude is imperative to enduring them and using them well.

    I've had general anesthesia for same day surgery, as a revision to my "tummy tuck." If i were to compare the differences in my experience between that and the inpatient stuff, there are two major differences: One, I "had" to walk into the OR, and I HAD TO walk out (EDIT: walk out of the surgery center, not out of the OR) under my own power. The drugs in the anesthesia/pain management cocktail were a little different, so that I was functional faster but way happy happy joy joy LOL. I went home from that pretty big operation happy as a clam, could have started a new business and who knows what all that day.....But the NEXT day I felt like shit on a stick.

    The surgeon warned me that my same day experience would be quite different from my inpatient experience, even though it was less than 12 hours' difference in time. The whole protocol was different.

    So, I think what's really important for you to understand is that THIS IS REALLY SURGERY FOR REAL. It is NOT "less invasive" or "simple." You are taking on ALL the risks of abdominal surgery in general and WLS in particular. Do NOT minimize or ignore the warnings about how big this is. This is not ingrown toenail surgery.
     
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    Elizabeth N.

    Elizabeth N. Herder of cats

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    Part two: Going home.

    Okay, let's assume you stayed at least one night and you have some minimal education about what to eat/drink and you go home with liquid meds and instructions to drink fluids and eat pureed or super soft foods as tolerated. That should find a nice medium between outpatient crapbands and open DS to RNY revisions. (Simplest to most complex.)

    First let's talk about the expectations of surgery in general.

    1. You've been loaded to the wazoo with a mega cocktail of drugs that mess with every possible bodily function. You did not go to the dentist and get Novicaine. YOU ARE IMPAIRED and it will take TIME TO RECOVER. You might not fart or poop for a few days. You might find your sleep, thinking, cognitive or motor skills to be strange. You had SURGERY. You got told to take time off work and have someone with you for a reason. This should tell you that it's a BIG THING.

    2. STAY OFF THE FREAKING SCALE. Good Gawd, this should be obvious, but apparently it ain't, so I shall spell it out. WLS is not magic. You did not get morbidly obese overnight and you will NOT see results overnight. Furthermore, you got pumped up with fluids like crazy for your surgery. So even if you THINK you've starved yourself into submission with whatever protocol, you have gotten a couple gallons of fluids in one day or half a day. A gallon of plain water is 8 pounds, salt water with shit in it is heavier. So YOU ARE SWOLLEN. This is NORMAL. DO NOT WEIGH YOURSELF, and if you are so stupid as to go home from the hospital and jump on the scale, please do not post about it weeping that you are not lighter. Please make a poster of this somewhere, okay?

    Let me be more excrutiatingly detailed. When you are in preop, you will get a bag hung to run into your vein. That bag is a liter. Four of those is a gallon, which equals 8+pounds. You go to surgery, which slows down your poop and pee. You get more of those bags along the way. Okay? You will NOT get rid of everything that goes in the vein. So just DON'T get on the scale.

    3. You are going to have a significant bellyache. Just where and how you feel that bellyache will vary depending on your procedure and whether it was open or laparoscopic. PLEASE OH PLEASE look up what happens in laparoscopic abdominal surgery, to see how it is NOT less invasive or what the fuck ever than open surgery except for the incisions. The thinking mind will look at that stuff and go, "OMG they're going to blow me up like a balloon and I will NOT be able to fart and burp out the gas and it will be in there to make me miserable and it will HURT!!!!!!" And you will be prepared for pain in your neck, shoulder, hip, chin, heart area, etc. because you will understand that gas bubbles go EVERYWHERE and must be endured until they resorb.

    4. If you have a surgeon with the tiniest bit of scruples--not a given--you will be sent home with instructions about what to imbibe and how to advance your diet. No matter what procedure you get, the results will be that you will probably feel every teaspoon of fluids you swallow. HELLO? YOU SIGNED ON FOR THIS. You wanted RESTRICTION (plus malabsorption if appropriate for your procedure). Welcome to restriction. Don't whine about the "impossibility" of 64 oz. of fluids daily, for I am now going to tell you how to get the 64 oz. that will prevent dehydration and it is EASY.

    --Get a measuring teaspoon, measuring tablespoon, a 1-oz. shot glass and a digital timer.
    --Get a container of fluid that you tolerate.
    --Do the math: 3 teaspoons-1 tablespoon. 1 tablespoon=1/2 oz. 128 tablespoons = 64 oz.
    --Take your teaspoon, dip it in your fluid of choice and imbibe. Wait one minute. Do it again. Repeat twice more. 1/2 oz imbibed. If you don't have nausea issues you are fine. If you have nausea issues, take your nausea meds.. If they don't work, CALL YOUR SURGEON and scream, because trust me, you can do this.
    ---Okay, you just did 1/2 oz in 3 min. Now you gotta do this 128 times in 24 hours. Guess what? Doing this takes 6.4 hours out of 24. Let's assume you sleep 8 hours, so we have 16 hours. Hell, you can still work the 384 teaspoons into your work day. And you will never feel it.

    See, the thing is, nobody goes into this with an understanding of a "sip." This is a problem in a couple of directions. One, most folks swallow too much and hurt or puke, or two, they feel the limitation and panic and think they are starving. Well guess what? YOU SIGNED ON FOR THIS. You made a choice to change your gut so that you can only take in a teaspoon or maybe a tablespoon of anything at a time. So you'd better learn what a tablespoon of intake is like in advance and wrap your brain around it, otherwise you are going to go bonkers from the shock.
     
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    Elizabeth N.

    Elizabeth N. Herder of cats

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    The phenomenon of the awakening and changed intestines.

    General anesthesia slows or even shuts down your intestinal activity. Getting your intestines surgically altered shuts them down even more. Perhaps a medical person can chime in here and explain how and why. I just know it happens.

    So, many if not most of you who have an inpatient procedure are going to experience lots of people asking if you've farted or pooped yet. The surgeon and/or the other folks will listen to your belly for gut noises that indicate things are waking up and going again.

    You will likely never be so happy to fart or poop in this lifetime as you will be when you finally let something out right after your surgery. Depending on your surgeon's protocol, you might not get cleared to eat a damned thing until after s/he knows your guts are awake and moving. You might not get ANYTHING by mouth till this point. The reason for such caution is that if stuff ain't moving, it's going to stay in there and very likely come back up. (Again, I hope a medical person can jump in and provide more detail.)

    Okay, on to the new world of gas and poop. IT'S GONNA SMELL AND FEEL AND LOOK DIFFERENT. At first this is because you had surgery. But if you had RNY or DS, it's also because what comes out is changed. Some of your intestine gets bypassed for food, so you don't absorb everything any more (well, for a time in the RNY). This means that different food remains are gonna come out. The type of digestive juice remains will also be different. I don't know about RNY, but in DSers there's a higher concentration of bile (or what remains of bile?) in poop, among other things.

    There's a very irritating myth out there that DSers stink. Um, no, it's the gas and shit that stink. And guess what? It happens with RNY, bands and VSGs too. If you alter any part of your gut in any way (and getting a band DOES alter your gut, all propaganda to the contrary--you implant a foreign object and your body will react to a lesser or greater degree), what you excrete will also be altered. So get ready and get used to the idea. There are lots of things you can do to reduce your gas and make your poop the right consistency.

    But we are talking about surgery and recovery here. So back to that. When you are fresh out of surgery, several factors will make farting and pooping more complicated:

    1. All those lovely drugs
    2. Your relative immobility
    3. The sudden and very dramatic change in your intake
    4. Lack of fluids
    5. Surgical soreness and the various protective postures you'll automatically adopt

    There are two things you can do easy peasy (well, okay, not always THAT easy) to improve the odds of being less miserable with the pooping: MOVE AROUND and HYDRATE LIKE CRAZY.

    You might get diarrhea, as in frequent, urgent and runny poop. This is normal.

    You might get constipated. This is also normal.

    However, all such conditions are important and are treatable. Talk to your doc about what s/he wants you to do. Some discomfort is normal. Misery is not, especially when it's prolonged. Both extremes are potentially dangerous and even potentially fatal. So TALK TO YOUR DOC about it.
     
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    andrea in the UK

    andrea in the UK Member

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    brilliant write up elizabeth, very good and full of knowledge, brings back the memories that i had already long forgot!
     
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    DuodenalSwitchaRoo

    DuodenalSwitchaRoo Taking a long scenic route!

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    This is awesome. I have read it a few times and liked it in other places. Do I have your permission to print it out and take it to hospital :)
     
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    Elizabeth N.

    Elizabeth N. Herder of cats

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    Sure!
     
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    DuodenalSwitchaRoo

    DuodenalSwitchaRoo Taking a long scenic route!

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    Bril. Thanks! I want proof in writing that I knew before hand how much it was going to suck lol. I'm a terrible sick person and when it comes to pain I'm even worse.
     
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    DuodenalSwitchaRoo

    DuodenalSwitchaRoo Taking a long scenic route!

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    Hope you don't mind EN, I put it all in a pdf so it could be printed and taken to hospital. Full credit given to you and acknowledged BF.org
     

    Attached Files:

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    Lori

    Lori Member

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    I printed it and I'm taking it with me... thanks EN and Roo!
     
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    southernlady

    southernlady Administrator Staff Member

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    Having had SEVERAL surgeries including the DS...my pre-op experience is slightly different.

    The difference being from the point of time they put the IV in me and added the happy juice...I honestly do NOT remember getting wheeled to the OR most of the time. The few times I do remember, my memory doesn't extend to the OR itself, just heading off toward the doors to the hallway This last time was less than 2 weeks ago. Yes, I remember heading to the doors of the OR but do not remember the OR itself.

    Next thing I remember is waking up in recovery. I come awake fairly fast. And have had enough surgeries to know to only ask to wet my lips...no drinking right at first. But they will either give me ice chips (except for the DS and my first jaw surgery) or wipe my lips with a damp sponge.
     
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    robs477

    robs477 Now an Angel in heaven

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    Wow, never seen that before! A lot of work! I read it a couple times a saved the .pdf. Am a pre-op you know and I've never had surgery, so it really is a lot of info! Thxs EN for all that effort in putting that together!
     
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    Elizabeth N.

    Elizabeth N. Herder of cats

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    Glad it helped. I remember waking up from my emergency appendectomy, puking my gizzards out, being told they had given me a magic drug aka Tylenol, and how badly it hurt....and being yelled at for not swallowing and controlling the puke. Being told I was "fine." Yeah right.
     
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    julie

    julie Member

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    Great post! I'll be pre-op for at least another 6 months if not a full year, but I already plan to print this off so I have it nearby for when I have surgery. Hope it's ok if I post a link to here in one of the DS groups I'm in on FB.
     
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    southernlady

    southernlady Administrator Staff Member

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    Sure...we like people posting links from here to facebook to help others find information.
     
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    CaraOC

    CaraOC Credentialed Bitch

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    This just cracked me up. Well written. I'm 7 days post op DS by Esquerra in Mexicali. I'm not only a patient but also an ICU nurse, so my slant on this was probably more comical. I absolutely love Dr G the anesthesiologist at MBC. I think he's the greatest I've ever come across. I think I have a crush on him. I had previously told his I did not want to be pushed into the OR without happy juice on board cause I know from previous experience I sort of freak a little to see this place from the view point of the patient. Well. I'm garbed up with my ass hanging out on my skinny gurney and believing I was being taken to my room to await my OR time. Wrong. My gurney gathers speed and jackknifed the corner BANG right into the OR. I sit bolt upright wide eyed like a hostage see Dr G behind me and start shouting at him using colorful expletives. I see him holding a large syringe of clear fluid I know to be Versed. He lifts my IV tubing and starts pushing this medication so fast his knuckles whitened. I know exactly how this drug works so I continue my rant at the speed of an auctioneer so I could speak my mind before the elixir hit my blood stream. Then it was lights out. I have forgiven him though.
     
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