IMPORTANT! Need anecdotal evidence that vets know more than surgeons

[southernlady]

True, just maybe a "hey, if you gag on a multivitamin, you might wanna get a pill crusher for after surgery" type heads up, but not making it a necessity.

EXACTLY!

I am one who took handfuls without a problem. I am back to that BUT the first 3-6 months, I was doing good to get one at a time in, and with a sip each pill, I was always full OF FLUID.

 

[newanatomy]

Going back to Munchkin's list, I think that in most cases 20 days of pain meds would be excessive, not that that is what she was advocating for in every case. I do see where on occasion it would be necessary but, I would not want to freak the surgeons out with that kind of suggestion.

 

[Munchkin]

Going back to Munchkin's list, I think that in most cases 20 days of pain meds would be excessive, not that that is what she was advocating for in every case. I do see where on occasion it would be necessary but, I would not want to freak the surgeons out with that kind of suggestion.

Actually this is quite common. That's about what I got and I saved mine for night time. Isn't your doc one of those who gives out very little? I think this much should be available for anyone who has the surgery. If you don't need it, great!

 

[newanatomy]

Actually this is quite common. That's about what I got and I saved mine for night time. Isn't your doc one of those who gives out very little? I think this much should be available for anyone who has the surgery. If you don't need it, great!

My surgeon gave me 8 of the lowest strength pills available, the prescriptions was for 10 but the pharmacy only had 8 available. He is a nitwit when it comes to pain management. He thinks the whole world is going to become addicted. I believe it is part of the Mormon culture to protect us from ourselves in this way. As Ron White might have told him, for me, he needed to crank that shit up to a Catholic dose!

 

[Munchkin]

My surgeon gave me 8 of the lowest strength pills available, the prescriptions was for 10 but the pharmacy only had 8 available. He is a nitwit when it comes to pain management. He thinks the whole world is going to become addicted. I believe it is part of the Mormon culture to protect us from ourselves in this way. As Ron White might have told him, for me, he needed to crank that shit up to a Catholic dose!

I thought he was one who did this. 10 pills...ridiculous!

Mine was open and I screwed up and left the hospital with nothing. Couldn't believe I had done this.

I called the doc's office and got them to phone in a scrip to my local pharmacy. H went and picked it up. The difference was day and night...within 20 minutes the pain was gone and I was able to relax. It was wonderful.

Pain relief in the hospital was horrible! I was on one of those pumps and you had to wake up every 10 minutes to push the button. It was just enough to take the edge off. Never enough to let you relax and sleep. More than anything else I wanted some real pain meds!

One scrip for good pain pills does not an addict make!

 

[more2adore]

Imagine a world where a doctor can't phone or fax in a prescription to a pharmacy... where you have to physically go to the doctor yourself and see the doctor to get it, no matter how you're feeling. Welcome to Australia. (At least, that's been my experience! Any other Aussies - feel free to correct me. I would LOVE to be wrong about this one and not have to go to my GP every cotton picking month to get a damn NSAID script renewed).

 

[star0210]

Munchkin...excellent list!
But I don't agree that people should need narcotic pain relief for that long. I do admit though that I have a huge bias against pain pills. In addition, I think I must have a pretty high tolerance for pain or something.
I had my surgery in Mexico and I had whatever pain meds were hooked up to my IV the first couple of days and when it finished they gave me supradol sublinguals (ketorolac) which worked fine. I was never in any pain.
I personally believe the longer you stay on hard stuff, the slower your recovery will be.

 

[jillc]

Hmm, I disagree @star0210 but that's probably because my surgery was open, and I had a revision so tons of stuff was done inside. Also, when I used to work as an RMT, people have varying levels of pain tolerance and it's not a mind over matter thing. Some peoples' nerves fire at a higher rate, and they generally are more sensitive. For instance, if a person has dealt with chronic pain for a number of years, they (usually) have a higher level of pain tolerance. Conversely, the opposite.
Anecdotally, my parents have a friend in his mid eighties who, up until a four or five ago had never felt much pain as he'd never really had much illness nor medical issues. It was a total shock to him when he started having aches and pains associated with aging. At eighty!
So it really does depend on the person.
I do agree that if you can cope without the pain meds, it is better to do that. I think I have about 4 pills left in my prescription, and didn't touch them much after the second week of surgery.

 

[southernlady]

Typically I have a high tolerance for pain BUT my jaw surgery brought me to my knees...my surgeon gave me a 10 day round and I had to have him refill it for another 10 days. I didn't take all of the last 10 days. Normally, 2-3 days is all I need. That's all I needed for my back surgery, for the DS, and even for the hand surgery I just had.

 

[revisionDS]

the #1 problem for DSers is drs just don't understand what malabsorption really means, especially in reference to a DSer. I have brought in diagrams, show what part is bypassed, operative reports-you explain why calcium, fat soluble vitamins are difficult for us to absorb etc...then they RX VitD2 in oil based??? Were you completly checked out for our 15 minute converstation why that won't work? Yes for sure Drs need a good grasp on what that means. Anything that goes through our GI system-anything will not be absorbed like it was before. You are not what you eat, you are what you absorb.

 

[Razbry]

I thought Dr Hess (now retired) had a great system for pain management. He put in a spinal block during surgery, and there it stayed for the next 10 days (length of hospital stay). I was never in any pain.

 

[DianaCox]

I thought Dr Hess (now retired) had a great system for pain management. He put in a spinal block during surgery, and there it stayed for the next 10 days (length of hospital stay). I was never in any pain.

Surely you mean epidural, and not spinal ... like this thing: http://www.myon-q.com/. But why were you in the hospital for 10 days? That's awfully long - most people are in for 2-4 days with a DS.

 

[graysland03]

Let's start with this...

Flintstones. More than few docs have told their patients to take these. They are made to fit the needs of a 60lb child eating and absorbing a normal diet. Does this sound like a DSer to you? No? This is not rocket science and no physician should be telling their patients to take these. Plus they are loaded with sugar and that's what we need to avoid. I'm not convinced these are really good for a 60lb child either but you get the point.


ADEKS. There is not enough of what we need in there. No way, no how. They are very expensive and not adequate for our needs.


Soft Gels. These are oily fat based gel caps. Get a brain. What do we malabsorb? Fats. Makes no sense to tell patients to take these unless you insist on 5X the normal dose to make up for our malabsorbtion.


Bariatric Advantage Products. Great. You managed to create another revenue stream for your practice. Too bad the pills you are pushing are not good for us. If you want to supply us with vites, wonderful. And we will buy them. But put a little thought and brainpower behind what you recommend. Too many of us are sheeple and will blindly trust you and follow your advice. Oh, wait, we are supposed to be able to trust you, so maybe you need to recommend an adequate supplement regimen. Take a look at vitalady as a starting point. She has done most of the work for you.


The Low Fat Diet. It wasn't me who said "Fat is your friend." It was Dr. Hess. And he was right. You are wrong. Eating a high fat diet is very normal for the average DSer. Because we can! This is due to the fact that we have extensive malabsorbtion and the fats we eat do not affect us. Those of you who specify low fat are doing your DSers a disservice. Eating a diet high in fat allows us to be satisfied and stick to the low carbs we need to lose and maintain. One size never fits all and postop diet recommendations need to be tailored to the patient's surgery.

RNY and sleeve patients most likely need to be very aware of fats and calories but DSers do not. All we need to remember is the only good carb is the one we don't eat. It's not a disaster for us to eat steak for breakfast. It's protein, not carbs. The disaster for us is eating all those low fat products that add in extra carbs and salt to make the food palatable. Don't believe me, go to the store and read some labels for yourself.


Pill crushing. Why? You did absolutely nothing to my esophagus to change or limit my ability to swallow. I can swallow anything post-op that I could pre-op.


Inadequate post-op pain meds. Stop this! The DS is major surgery and it is not acceptable for you to deny patients reasonable pain relief. At least 10 to 20 day's worth for a normal recovery. Your patients will be able to move more and have fewer complications if they are not in pain. Pain is debilitating, slows your recovery, and makes it more difficult to do the things we need to do to recover. 2 or 3 days worth of pain meds is not enough.


Where did you get your NUT? Did you save boxtops?

Our usual advice to the pre-ops is smile and nod. Be agreeable and keep your mouth shut.

There is no excuse for your NUTs not understanding the procedures you do. It is at least partly your responsibility to educate them. NUTs are responsible for a lot of the misinformation out there, including poor diet recommendations. And most know nothing about supplementation requirements. Low fat and high carbs is inculcated into their being from the day they enter school. Working with DSers requires a change in mindset. And acquiring a lot of new knowledge.

Do you give all patients the same post-op advice? If you do please work with your NUT and come up with something better.

These people represent you and your practice when they speak to your patients. Do you even know what they tell your patients?


The Draconian Pre-op Fast. The ASMBS says not necessary. So why is this requirement getting worse instead of improving things for the patients? Seriously, why the restrictions 4, 5, 6 weeks before surgery? I get it that empty bowels and a glycogen deprived liver make surgery easier and better for the surgeon and the patient. Anything more than 1 week max is excessive. And many of the diets you prescribe lead the patient into surgery in a state of nutritional deprivation not conducive to proper healing.


For you, all of this is just another day at the office. For your patients this is a life changing event. Why not try to give them the best possible experience and outcome? The ASMBS says obesity is a disease. Not a character flaw. Please try really hard to believe this. We have already suffered enough. We don't need to suffer more to be deserving of losing weight. Promise.

The end of chapter one.

Gotta say the boxtop comment was freakin hilarious.

 

[Munchkin]

Chapter 2

Part of your job as a DS surgeon is to assist other docs trying to learn how to manage our care. You need to do inservice lectures and actively educate your peers. I did inservice for 2 medical groups in Minnesota. For free. And if I did it, you can too. The average PCP/GP out there in the trenches knows less than nothing about the DS.

Just today there was a long term post-op posting on FB about how he is losing all his teeth. But it can't be because of the DS. His DOCTOR told him his calcium is fine, he doesn't need to supplement at all...so this guy has never taken a calcium pill. I wonder how much bone this guy has left and I bet his PTH is off the charts. But I'm sure his DOCTOR doesn't test that. Probably doesn't know what it is. It's probably too late to save him. And I bet his supplement regime is all wrong all the time so he has other issues as well.

Why does this happen?

Everything in a medical group is done by the book. Literally. In the interest of saving time and increasing productivity, the doctor actually makes very few judgement calls. He/she looks up the suspected diagnosis in the book and does what the book tells him/her to do. We just need to add a few pages to the book explaining how to care for the post-op DSer.

 

[Razbry]

Surely you mean epidural, and not spinal ... like this thin: http://www.myon-q.com/. But why were you in the hospital for 10 days? That's awfully long - most people are in for 2-4 days with a DS.

You are probably right. It was a long time ago, and I wasn't clearly thinking. All I know was that it was a thin tube inserted somewhere in my back. 10 days was not uncommon for a stay in the hospital for Dr. Hess patients. He was a large fish in a small pond, and he knew how to work the insurance system.