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Before & After
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Elmer L. Valin, M.D.
I Actually did not meet Dr. Valin until pretty far on in the process, which was fine - his team takes such good care of you and they know everything you need to know other that doing the actual surgery - that's his job. He was small and quiet and to the point, not overly friendly, but just matter of a fact. He knew his stuff for sure - and everyone talks about him - great reputation - amongst his peers too - the anesthesia team raved about him, before I went in and that was without me asking - they just offered the info. I knew I was in GOOD SKILFUL HANDS - if you add his staffs bedside manner along with his incredible knowledge you have the PERFECT team. I am 2 days post op - just remember the first 24-48 hrs are the worst - it gets so much better when you get into your own home.
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This story is copied from an email I sent to a perspective patient of my surgeon, Dr. Elmer Valin in New Haven, CT. I was seen at Saint Raphael's hospital in New Haven and this is my recollection from the pre-op diet all the way through my first day home after surgery ....
****PLEASE REMEMBER THIS IS BASED ON MY INDIVIDUAL EXPERIENCE - I HAD LAPROSCPIC GASTRIC BYPASS - MY WEIGHT WAS 254 GOING INTO SURGERY I DO NOT HAVE DIABETES OR SLEEP APNEA OR HIGH BLOOD PRESSURE OR ANY OF THE THINGS THAT CAN GO ALONG WITH MORBID OBESITY. YOUR EXPERIENCE MAYBE DIFFERENT?????****
You will start the pre-op diet one week before - which isnt too hard at all - and I even slipped once in a while and ate a cookie or something (just one - not the usual ten or twelve) - so it's not SUPER rigid- just try to stick to it as best you can - I lost 6 Lbs that week and you probably will too. The day before surgery you start your bowel prep - I dont know if you have ever done this before, but I was scared to death about this part, not sure why - the unknown I guess. I was like do I have to stay sitting on the toilet all night? Should I be no more than 6 feet away from it all night? Can I go out at all? How long will it last. What I did was stay on full liquids that day too - I woke up and had tea and then the rest of the day drank water and chicken broth ( I was too nervous to eat anything else pretty much anyway) I figured this way when I did my bowel prep it wouldnt be so gross or painful. I had been told by a nurse I know to smother my butt in vaseline after each poop so the sting wouldnt hurt so much - so you can see why I was so scared huh? WELL - I couldnt take the stuff until 5:30 pm the night before because I was working until 5 - they want you to start it at 3:30 the day before surgery to give your bowels time to totally clean out ( believe me you wont have any sort of major poop for about 10-14 days from then anyway - just some squirts). They told me starting at 5:30 was fine as long as I did the full clear liquid thing for the full day instead of half of the day....I figured the sacrife was worth it. Long story short - it didnt hurt, it didnt sting, it didnt keep me up all night, and it was more of an inconvenience that anything else - all in all it was NO BIG DEAL AT ALL.
Next step - and as I started to say, everyone I have talked to that had this done with Dr. Valin at Saint Raphaels was on the same time schedule....you are scheduled for surgery at 7am!! The want you there at 5:30 am!!!! That is getting up early for us ---be prepared!! My mother lives in North Western CT and came to get my boys on the bus (I have 7 year old twin identical boys - they will be 7 in 3 weeks) and be there for when they get off the bus - she arrived at 4 am so left her house at 3am....I owe her big time! LOL Anyway - this is what happens next. step by step.
STEP ONE: CHECK - IN
1. The day surgery until you are going to doesnt open until 5:30 - the doors are LOCKED so dont plan to get there much before that- you will probably encounter a line of people waiting to get in - for all different procedures and all different doctors - I checked out the fat people and they checked out me and we gave eachother a secret smile as if we knew why we were there....they let you in and you all wait - the say NEXT and then you sit in the checkin room - get your ID bracelet your allergy bracelet - verify your name and all your demographic info verify why you are there...that takes 5 minutes - when that is done they walk you and your spouse or whoever is with you to a room - not sure and have you get undressed and put a johnnie thingy on and lay down and wait some more -
STEP TWO :GETTING PREPARED PART ONE
2a. After waiting a short time - this whole pre-op process I found to be very nice, very relaxing, the nurses were the best set you will have (tell ya more about that later!) they joke and they are friendly. The nurses sit at the foot of your bed with a laptop and ask you a million questions - health questions mostly, they weigh you - you put your belongings in a bag that they stick under the bed. And then you wait about 40 mins or so for the next step.
STEP TWO: GETTING PREPARED PART TWO
2b. At this point and with the surgery scheduled for 7am it is about 6:30 - you say goodbye to your spouse or whoever and they wheel you on the bed into the hallway - where you wait for a few minutes for the people to clear out - it seems that alot of people have surgery scheduled for 7am and it's a bit of a hussle and bussle with everything going on at once - I told my nurse it was like waiting on the tarmack at the airport for your plane to be the next in line to take off - all the guernies are lined up with a nurse by each one just waiting their turn to head where they have to go - down the surgical runway. You are then wheeled through the maze they call Saint Raphael's to the anesthesia prep room - that's what I call it anyway.
STEP TWO: GETTING PREPARED PART THREE
2c. This anesthesia room is empty except for a lot of cabinets and draws all down one wall - they wheel you in and again line you up with the others all against one wall - I was first in line and then I had a nice old man next to me who was having a knee replaced and then next to him was a young hunk who tore something working out (poor thing!). That;s as far down the line as I could see - there were about 5 more beds down the line after that and that filled the room - we were all there to get hooked up to IV's by the anesthesia team. My nurse was Maria and she was the sweetest thing EVER - she hooked my IV up and I just sat there until it was 7 - not long and everyone was pretty chatty so it went by nicely. No turning back now!!!!
STEP THREE: GOING INTO SURGERY
3. This is the shortest step I will write about because I remember the least - and that's a good thing. The wheel you again through the Saint Raphaels Maze - through BIG BLACK SLIDING DOORS - the entire hall way is white and pretty and relaxing and calming and then you get to these BLACK DOORS ( I mean the glass is even black ) I complained about this - that the color was a little forboding and couldnt they make them pink or purple or something - just anything a little more inviting. They said no one had ever said that before - which I found hard to believe....these doors let to surgery. Inside it was FREEZING - and white and silver and shiny and stark. Instruements EVERYWHERE - machines EVERYWHERE (try not to look too closely!). They transfer you from you guernie to the surgical operating table and lay your arms out like you are on a cross - they are placed on boards where they are going to be hooking all sorts of things to you - which they dont do until you are out. Nothing much happens - no pain - they give you some oxygen to breath in and poof that's it...................onto recovery.
STEP FOUR : Recovery Room
4. You wake up feeling yucky from the anesthesia - no pain just yucky. If you are like me you wake without the breathing tube in ( if you had breathing troubles during or after surgery they leave the tube in after you are awake for a short time) - with a little oxgen line going up your nose - just that thin wire thing with prongs in you nostrils - nothing major at all - you will have a cathetar in and an IV with pain meds, antibiotics, and fluids hooked up. You will be in recovery - on my surgery they didnt have a room available yet on the floor (they have a special floor for us called Verdi 5 west - SUPPOSEDLY strictly for bariatric surgery patients and our special needs and nurses trained in our special needs ) they said sometimes you have to wait in recovery for a while until they get you into a room - I was there for 2-3 hours, but my husband was with me and I was so out of it that I dont even know if I was asleep or awake most of the time. It was fine - everything is so fuzzy at that point you dont care either way.
STEP FIVE : IN YOUR OWN ROOM - IT BEGINS
5. The rooms are not private - let me tell you that right off the bat - there is one private room and you have to "know someone" to get that room. So you will have a room mate. My experience at Saint Raphaels was not a good one - but I am sure yours will be fine. It was just the luck of the draw that my room mate was an older woman dying of cancer who's intestines had collapsed - her bariatric surgeon ( nothing to do with weight loss - just regular GI surgery with a different Dr,) had done a bypass on her to get her to work right again during her last year of life. She had been "blocked up" for 2 weeks and now things were working again so you can imagine she quickly became "unblocked" and I mean QUICKLY - all over the floor, her bed, the bathroom the hallway - you name it - she did this at least 3 times a day and at least three times a day housekeeping came to our room to mop up everything - it was really disgusting! She never slept, kept her tv on all night on full volume and kept all her lights on all night - not that you are going to beable to sleep that first night anyway - so dont expect too - the bed is not comfy, you are sore and VITALS are checked like every couple of hrs wether you are awake or not - blood pressure, temp, oxygen levels and they ask you how much pain you are in from a 1-10 scale - it doenst mean they will help you with that or even get your nurse for you - it just means they need to enter that into the computer to account for any changes in your stats...I learnt that quickly. Dont ask them for anything - they ONLY take vitals and move onto the next person. Your IV will be changed often and they will be bringing different bags of things to attach to it - pepcid for acid and gas pains - fluids - anti nausea stuff ( I never felt any nausea at all) and morphine also goes in this way - with a needle injected into the IV line. The morphine takes away the pain, but doesnt really knock you out (I had a c-section for my boys and the morphine I had then KNOCKED me out - wow did it ever - I would be fast asleep in seconds - but I also had a pump then and pumped myself..) they give you more morphine every 3 hrs - but they dont come automatically - you have to call for them - and then allow 30-90 minutes for them to arrive ( again this may just have been my unlucky experience with Verdi 5 west - they were very busy when I was there) - your IV system - the box it is hooked up to - will periodically just start BEEPING for no reason - usually when you are just falling asleep finally - it means NOTHING - but again, you have to call a nurse - you have a little button to do this - and this may take a while for them to arrive. It gets very annoying. Your throat will be sore from the intubation tube during surgery but you cant drink anything until the following morning when you have to swallow the syrup and have the xray done to make sure you have no leaks. They will give you a mouth swab - it's like a little green sponge on a stick that you are allowed to dip in water and rub on your gums to keep your mouth moist - it's disgusting eventually because it gets all slimmy and you will need a fresh one - I lived with that thing in my mouth getting every drop of moisture I could. You will also get shots of Heparin every 4-5 hrs or so which is a blood thinner to prevent clotting - they have to inject this right into your stomach which I know sounds TERRIBLE - but believe it or not it the needle does not go in far and it's like a tiny pinch - leaves HUGE bruised though with each shot - I still have mine today - three weeks post op. You will also have to wear "stockings" which are like the same material as the blood pressure cuff that tighten and loosen automatically around your legs. The inflate then deflate to keep the blood moving in your legs to also help prevent blood clots - you have to wear these for most of the day the first and second day - The first day there is long and tiring and all you want is a drink - you are not hungry in the slightest and nothing really hurts too bad - hardly any pain the whole time for me - my score on their scale was maybe a 4 at the most but usually a 2...WARNING the tv SUCKS!!!! You get like 4 channels - you will be lucky if you have it done on a week day at least there's something to watch - on the weekend it was just basket ball on every channel! All four of them! Oh yeah almost forgot you have to walk this day - walk walk walk - do it as long and as much as you can - it really helps - I tried to go every hour or so around the nurses station - you will be very gasy and gurgly and the walking helps with the gas pains - they are pretty bad at times- be warned. You will feel so much better after you walk them off though!!! PROMISE!!
STEP SIX: the leak test
6. I was awake the next morning at the crack of dawn having slept about 2 hrs total in 20 minute sections. The docs did their rounds early - say 7am and checked on you - took a peek said you look good and moved onto the next patient. I would say breakfast came around to all of those that could eat (not you!!) at 8ish. An orderly came to get me in a wheel chair - pretty early for my leak test - wheeled me to some GI unit - I waited sitting in the chair for 30 mins to go in (I feel asleep sitting up - ) along with several other hospital patients all having different tests in the Gi unit - they then wheel you again through the Saint Rays maze to a scary room. With a humungous machine in the middle. You stand up and they put you with a xray screen behind you and one infront of you pressing on your belly ( it doesnt hurt) and ask you to drink the liquid - it tastes bad, but its tolerable. It's really cool you get to meet your new pouch today for the first time and actually see it and how it works - you will be told to take several dry swallows (these are tough since you are so parched and so thirsty and there is no moisture in your mouth - not even from the liquid - my throat was sore and I was hoarse for a good week after surgery -not sure if that is normal or not - bu I had a hard time clearing the hoarseness from my throat due to not being able to cough as hard and loud as I wanted to beacause it hurt) anyway you see the liquid fill your little pouch and ooze down through all the tubes - no leaks YEAH!!!!! They wheel you back to the main GI area where you wait again - 20 mins or so for an orderly to wheel you back to your room.
STEP SEVEN : I am leak free - give me water!!!!!!!
7. All happy that I am leak free I cant wait to take my first sips of water no matter how small a quantity I get I just want to swallow something wet...lol...I am back in my bed and waiting for water - I waited 3 hrs...Dr. Valin has to review the leak test and issue the order to get you started on stage one and the nurse has to review the order and then actually make it to your room to start you on it. When she finally does you will get a teeny weeny measuring cap (like the type you get with cold medecine) and you can fill it up and take an hr to drink it - teeny teeeny sips - it tastes so good though!! It feels good going down and inside too. You pretty much do that the rest of the day - this is day two post-op. They remove your cathetar at this point - which is painless and quite a relief - except now I realize if I need to go to the bathroom I have to actually get out of bed - which is the tough part - once you are up it's ok - it's just the getting up part that hurts..the less you are hooked up to things and the least amount of wires and tubes and things you have to drag around with you the better when you go for your walks - remember walk walk walk walk - (it is a little awkward the first day - you have so much to carry as you walk - but a nurse will help you and then eventually show you how to unplug your own IV from the power source so you can walk alone and then plug it back in - it's a pain in the butt - they should have battery operated IVs) Anyway - they have you measure your pee in a big cup thing - you put the cup thing ontop of the toilet and fill it then place it in this holder so they can periodically come by measure it - make sure you are getting enough fluids then dump it. Also I forgot to mention you will have a drain - they call it a JP which stands for a Jackson Pratt ( go ahead impress them with your knowledge! LOL) - attatched to an inscicion that looks like a see through mini hand granade - it is attached with tubes through your belly to drain out yucky stuff and blood and goop and stuff - they have to empty that several times a day too - it doesnt hurt - it's just kind of gross when you see what comes out of it - try no to look! They have to measure what comes out of that too. That port is the last thing to go before you go home. You start to feel a lot better as this day goes on - especially if you are walking walking walking. Dr. Valin came to see me said I was doing great with my stage one water and that he would put me on stage two the next morning and I could go home - so I had my surgery 7am Friday and was home by 1pm Sunday - NOT BAD HUH!??
STEP EIGHT - going home today!!!
7. Stage two was a plethera of clear liquids - tea, green jello, chicken broth and water - you will barely eat a bite of each - you just arent hungry and get full so quickly - as long as that stays down and you do well he gives the ok to send you home. This is the longest part for most people - the waiting to be signed out. For me I was lucky (guess this made up for the poop all over the floor!!) Dr. Valin said I was free and probably about 1.5 hrs later I was in the car on the way home - usually that process takes 2-3 hrs...be patient.. Dr. Valin removes your port/drainage thing asks you to hold your breath and count to three - it is not fun - not painful - just not fun - there is about 16 inches (this may be an exageration??) of tube INSIDE you attached to this outside JP port so it is not a nice feeling when he YANKS it out - just be prepared that's all I can say on that. He puts a bandaid over where he pulls it out. The nurses remove your IV's ( I had 4 !) and put bandaids on those - you get dressed and wait for a volunteer to wheel you out - that can take a while they say if the hospital is busy.
That's about it - the rest you are in the comfort of your own home and feel 100% better - I mopped the kitchen floor when I came home and did a load of laundry - not reccommended, but that was how good I felt. He tells you to start full liquids (clear or not) the next day - strained creamy soups, broth, protein shakes, and water water water - you will have gas pains alot - and walking really helps. Dr. Valin sends you home with 4 prescriptions - two over the counter (pepcid and gas-x) and two you need to get filled - Tylenol with Codiene liquid (which I hardly even touched - there really is no pain - just gas discomfort) and an anti nausea medecine to take as needed - which I havent had to. You return in 10-14 days to get the staples out - which again is like nothing. He doesnt see you for another 6 weeks after that! Let your new life begin...................