Jojeki

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I have been at a stall for weeks but eating is getting easier.  I find that my mind, mouth and pouch are finicky and some days I can tolerate chicken and other days just putting it in my mouth is a chore to chew.  It gets easier...or so I am told.

I find that the more I drink the thirstier I feel, how is that so?  I think if I keep drinking I am going to float to the bathroom, but if I do that, how am I supposed to get my exercise in via walking? LOL

Motivation to exercise is lacking, I keep making excuses.  I did manage to make it to play tennis one day this weekend but I know I need to do more than that.  The weather is cold and that doesn't help, but it gets easier...or so I am told.

Lastly, the damn scale won't move and I don't mean move its position, I mean the numbers won't move. Each time I walk in the room where the scale is it taunts me.  I checked the batteries and I even moved the location of the scale figuring it is on an uneven spot on the floor.  I guess we need to try everything to justify it not changing, but you guessed it...it gets easier to avoid the scale then be surprised later...or so I am told 

Talk about a complete change of eating.  I was not an overeater, a binge eater or someone who ate too much of a bad thing.  I just could have made better food choices during my life.  I am not saying I want to go back to they way I was eating, I just want to get stabilized in a "routine" of eating without it being such a chore.

Before WLS I wanted something, I ate it.  Now 3 weeks out from surgery, I want something, I take a bite and I don't want to eat it.  I am actually struggling everytime I look at food and it turns my stomach.  Is this normal that the brain, the mouth and the pouch seem to be at war with each other?

Typing one handed right now.  Since the hospital stay I was experiencing pain in my right wrist extending up my forearm everytime they pushed certain medications.  Some would burn, others made my hand and forearm cold and numb, and some even made my forearm swell and get red.  I told each nurse treating me as it happened, not sure if they documented it.  I especially found that when the Potassium and the Prevacid were going through was the worse.  One nurse in the PACU listened and lowered the pump so it would filter the potassium slower, it helped but was still painful.  On the floor only 1-2 nurses that had to manually inject the prevacid would go slow, or flush in between (if I remember correctly).  What aggrivated me was that they still had the original IV in my left hand and I asked why couldn't they use that to inject medication and give the right had some relieft and I was told this hand was what they have been using and would continue.  The removed the IV on the left hand the night before I left since it was not being used.

Since being home I have had intense pain radiating from my hand, into my wrist and up my forearm.  I have also had swelling and numbness where I could not feel sensation in my hand and wrist.  The pain is so excrutiating that the pain medication I am on during home recovery is not even helping.  I have tried heat, ice, a wrist brace and nothing helps.  I placed a call to the surgeon's office this morning to see what they recommend.  I am also going to mention it to my own doc when I see him today.  I need some relief and answers as to why this is happening.  I am fearful that between the IV placement and all the different meds being pushed through that somthing may have gotten damaged.

I had my surgery on 9/14/10 for a revision from a Nissen Fundoplication to a RNY.  When I got to the hospital they informed me that the surgeon was “moving right along” and I would probably be taken in a little earlier. After the initial paperwork in admitting I barely had 10 mins to sit with my family before we all got whisked into the pre-op area. Even at that point it still did not seem real what was about to happen.

No sooner did I get into my hospital gown then I had a stream of people coming to speak with me from anesthesia, the surgical team, nurses, doctors, students, you name it, I got introduced. Of all the people I remembered one name, the name of the anesthesiologist. I figure that was the more important other than the surgeon as she was in control of my life. I was told that I would have to have a heparin shot to thin my blood and would have it regularly while at the hospital.

I don’t even think I had time to think about what was about to happen as I had so many thoughts in my head and emotions had no place because I could have changed my mind. My husband and my oldest daughter were with me and they were cool and collected. I honestly could not tell you what they said to me as I was being wheeled away, but I vaguely remember either family or one of the OR nurses saying it was beginning of my new life. I don’t know why but I got a tear in my eye as I was being wheeled in.   I think part of me for a quick second thought what if something happened to me on the table, I was sad thinking about my hubby being without me. The other part was thinking about the beginning of my new life. Wow that was scary, it was like I was saying goodbye for good to someone I have known my whole life, ME. I wiped the tears away quickly before I got into the operating room. I really don’t remember much other than them confirming my name, date of birth and did I know what procedure I was going to have. That was the last thing I remembered (can’t even remember going off to la la land).

As I came to I was in recovery and remembered that I kept asking for a swab to moisten my mouth. That cup of ice water and swabs was my friend for the next few days. I drifted in and out during recovery after a 4 ½ hr surgery. My family visited me in recovery and then they were gone. I was told that there was a room for me and that I would be going soon. Some time had passed and I was being wheeled to a different section of the PACU (Post Anesthesia Care Unit) along with a few other surgical patients. Apparently there were no rooms available on the surgical floor that we needed to go to. All in all I was in that PACU unit for 24 hours! Thank goodness I finally had the upper GI test in the morning and got to take the nasal tube out, that sucker caused so many problems and discomfort through the night.

The first nurse and the last nurse I had in the PACU were wonderful, but the one nurse Susan that I had from 7 pm until 7 am I did not care for her beside manner, she was very condescending and downplayed my concerns.  Instead of explaining nicely that my constant use of the swab could be causing the nausea I was experiencing she bitched at me that she was not going to give me any more medication for nausea.  I was sure to let the surgical team know of my dissatisfaction with her.

I finally received word around 4-5 pm the day after surgery that a room was ready. When transport came to bring me upstairs to my room we got stuck behind other gurneys near the elevators. For some reason there was a computer glitch or something and none of the elevators in the hospital were working except for this one tower passenger elevators. One by one each gurney had to have the rails taken down, the medical pumps removed from the pole and the head of the bed brought into a full upright position. I thought I was hallucinating what was going on until the elevator doors kept opening and people were yelling and asking what was going on and why they had to take the stairs. I finally made it to my room and had a barrage of people streaming in. I was on all sorts of monitors including a breathing treatment every 6 hours. Prior to coming up to the room I had the catheter and drainage removed. 

The surgeon finally came up and explained to me what had happened during surgery. Apparently the hernia came back and was worse then it was 5 years ago. He explained it was approximately the size of a softball. I also had scar tissue that had formed against the lining of my lung(s) and had to be carefully removed. He undid the old hernia surgery, repaired the new hernia, repaired the esophagus and did the RNY gastric bypass. The pain that I was experiencing in my chest in addition to the gastric bypass area was due to all this work that was done. The drainage they had in for 24 hours was to remove any additional air, blood and fluids near the lungs. I had breathing treatments every 6 hours up until the day I left and my oxygen was monitored regularly. The only time I had the finger probe off was when I went to the bathroom.

I had the surgery 9/14 and by 2 days later I had fallen asleep for the night and 2 hours later when I got woken up for my stats I complained to the nurse about severe left shoulder pain. The nurse was not sure why she thought it was perhaps the way I slept. I have been using Gas X strips as directed on the box and taking the pain med every 3 hours as recommended and nothing is working. I do get up every hour and walk around for at least 10 mins or so and I have been out of the house doing plenty of walking as well. I am not able to tolerate the texture of the protein drinks and I was able to get them down no problem before surgery. I am at least getting in the Gatorade G2 per the suggestion of my surgeon for the electrolytes. I am also having broth and sugar free popsicles. This hasn’t been easy the past 2 days of being home but I am sure it will get easier.  

Ok, peace out everyone....will post when I have access and feel up to it.

These are the questions that I asked my surgeon and his staff and the answers that I was given.  Remember that not all surgeon's are the same and some surgeon's may do things differently.

1. Are there any reasons why the procedure may not be performed after you open me up? If there is too much scar tissue and not enough viable tissue to do the RNY
2. If this is Lap surgery, is there any situation that might cause you to switch to an open? Cannot access area to operate due to too much scar tissue, liver and other organs in the way
3. What percentage of your patients receiving the revision surgery from the Nissen to RNY have had major complications? What kind? Why do you think these happened? Only had 1-2 patients that had problems with scar tissue, leaks or problems with the diaphragm
4. How small will my stomach be after RNY surgery? Approximately the size of an egg / 30 cc
5. Are you planning a distal RNY or a proximal RNY? What is the difference?   Proximal - Difference is proximal is higher up for re-attach of intestines and distal is lower. Usually distal is done for those weighing into the several hundreds and need the weight to come off faster with less absorption.
6. If RNY, how much of my intestine will be bypassed?  About 2 feet / 100 cm, They tend not to go more than that so as to leave enough in case you develop problems later down the road. They do not do less because they want the organs to sit inside in a good enough fashion that is natural
7. What is the advantage to having this much bypassed as opposed to less/more? Too little can cause bile in the pouch because of the short length. Too long can cause gas and bloating because of too much food sitting and not being processed.
8. Am I able to have upper GI tests or Endoscopy tests after a RNY ? An endoscopy can still be done, but just not on the blind stomach (part that is detached), you should avoid an upper GI unless done at a bariatric hospital because the liquid intake is different for the tests. You can still do an MRI but a CT scan may be different. Could not remember the reason why if it had to do with the dye or not. That was all I got for now, I was trying to think of any scenarios or tests that would be needed
9. What is the average length of stay at the hospital for Laparoscopic?   Open? Laproscopic 2-3 days, Open 6-7 days
10. What is the average recovery time at home before resuming work? Laparscopic 2-3 weeks, Open 4+ weeks
11. Is the RNY reversible?  What is the procedure to reverse? Over time the pouch created could stretch back almost to the normal size of a stomach if you are not careful. The RNY in extreme emergency cases may be not so much reversible depending on the circumstances, but can be done as some sort of revision to something else. It is risky and can cause more problems because of the anatomy change. Basically try to put the anatomy back to the original anatomical configuration as best as possible. It is complicated and could cause other problems down the road.
12. Is there a possibility that I will experience problems with the GERD again? This should not occur because there will be basically 3 surgeries going on for me, Take down the Nissen Fundoplication, repair the base of the esophagus if needed, do the RNY procedure
13. Will I need to take antacids after surgery? Possibly Pepcid AC for 2 weeks post-op as chewable or liquid
14. How soon after surgery can I exercise? What exercises should I avoid? Wait at least 6 weeks for Zumba and Tennis or anything active like that, swimming ok after 2-3 weeks as long as it is gentle movements
15. In case of an emergency that cannot wait for office visit, what type of ER Doc should see me? Always try to get to a hospital with a Bariatric program
16. Will I have problems with diarrhea or gas post-op? How can this be treated? Yes diarrhea and gas are possible the anesthesia takes approx 30 days to fully leave your body. GasX does not necessarily speed up the process, walking does. The gas is elsewhere in your body and eventually gets absorbed into your intestines, etc and out as farts, etc (sorry had to be blunt). The diarrhea occurs because of the different eating habits, more water, less solid food. In time this also passes as long as you are eating balanced foods.
17. Will I need to wear a girdle after surgery? You don’t have to wear one but if it makes you feel better you can use Spanx or something similar as long as it is not too tight.
18. How many follow up visits are scheduled post-op? And how often?  Will find out about post op after surgery. I think it is possibly 2 weeks, 1 month, 3 months, 6 months and either 9 months or 1 year then once a year afterwards.
19. How much weight loss is considered "too fast" and would be cause for concern? At first weight will come off quickly then taper off to 1-3 lbs a week average. Any faster than that will have to assess diet and speak to nutritionist.
20. How do you avoid Hypoglycemia? Avoid by making sure to have enough protein in the beginning of the day, eat per guidelines and avoid sweets. Make sure to drink enough fluids and get proper rest at bedtime. If you experience problems see the nutritionist for assistance with diet.
21. I know a blockage can occur. How would I know there was a problem? What would I experience if there was a blockage? you will know if blockage as you will experience extreme pain, nausea, possible vomiting. Get to ER that has bariatric program to be checked.
22. I have read that if you have a blockage to drink a mixture of water and meat tenderizer. Is that true? If not, how do you get the food unblocked? Do not use the water / meat tenderizer LOL, Blockage not always cauesd by food, could be narrowing somewhere along the line, stricture, etc.
23. Will I have drainage tubes in my incision or elsewhere? How many and for how long? Depending on how the surgery goes there may be a drainage tube in one of the ports used for the laparoscopic tools. This will be removed prior to leaving the hospital.
24. How can this surgery affect health problems I might develop later? Cancer (treatment), need for stronger meds for arthritis, osteoporosis, etc.? Always take supplements as told to, have proper nutrition habits. If problem should occur in blind stomach would have to cut hole leading from outside of body into the blind stomach and stick camera down in there to check it. If problems develop in re-routed intestines would have to do the same as the endoscopy cam sent down throat can only go so far. There is always possibility of developing arthritis and osteo prior to surgery and it can advance afterwards if you are not geting enough vitamins and calcium.
25. Is there any risk of cancer or other problems in the bypassed portion of the stomach? How will these be detected post-op? Anything can happen whether or not you have the surgery. As far as detecting in the “blind” stomach an incision would have to be made on the surface and into the detached / blind stomach and a camera sent in to look around
26. I know a blockage can occur. How would I know there was a problem? What would I experience if there was a blockage? Extreme pain anywhere from chest to lower abdomen, not able to pass gas or move bowels, vomiting, etc.
    
     
27. Can I take Tylenol or Tylenol PM before surgery?   Tylenol is ok to use but discontinue use of Ibuprofen

 

28. Do I have to do anything special the last few days before surgery, such as a special soaps or laxatives, etc? Nothing to eat after midnight, do not have to take any special medicines, shower then use Hibiclens (sp?) 3 days in a row before surgery.

 

29. How are the incisions going to be closed? Staples? Stitches? Other? There will be staples, dissolvable sutures and non dissolvable sutures. My surgeon also adds a few sutures on the staple line just to be certain.

 

30. Do you cut the acid producing nerve to prevent ulcers? Yes it is cut

 

31. During lap surgery, are you able to "check" other organs? Just the organs in the general area of the surgery

 

32. How long will I be in surgery for RNY? Because this is a revision from the Nissen Fundoplication to a RNY 2-5 hours depending on scar tissue, etc.

 

33. What are your standing orders re being contacted by nursing staff if I feel I need you or if prescribed pain management isn't working? Patient Controlled Pump with pain killer, then at home liquid Roxicet most likely

 

I went last week to meet with the surgeon, however he was out sick the day I showed up but i was determined to speak with someone, anyone to ask alot of questions.  I went armed with a printed list of 60 questions, yes, I said 60 questions.  If you want to know what I asked, just let me know.

That day I got most of my answers but I asked some of them today when I finally got to see the surgeon during the Pre-Op appointment.  At one point during my questioning he asked what I did for work, I thought he was going to talk to me about when I could return.  I told him I am an Administrative Assistant and asked why did he want to know.  He replied that he could tell be cause I was so organized and detail oriented and futher stated that he was impressed with my questions and it showed that I was a very educated person.  I felt good about that.  To me it showed that he recognized how serious I was about this surgery and wanted to know as much as possible to be successful afterwards.

I can understand being a busy office, but when I call 1 and sometimes 2 times a week for 4 weeks straight asking for an answer and keep being told "I'll find out and get back to you" that p*sses me off!  It is not a complicated question either.  If this is what the support is going to be like after surgery, WTH.

Ok I vented for today, how is your day going?  LOL

The cardiologist has cleared me, the stress test is done and so is the psych consult.  The only things remaining unless something else pops up is the nutritionist appointment and the Upper GI test both this week.  From there keep your fingers crossed that the insurance will approve me.

I have started dieting on my own since July 4th and I am not sure how much I have lost (don't own a scale), but as I say, I don't need a scale to tell me I am fat, that is what mirrors are for.  I can see a difference in my facial features, my face looks thinner.  You know the saying, "you notice it in your face first".  As long as the scale is moving down I am happy, I want to prove to myself that I can do this.  I have been keeping the food log on here as well and I update it every night with my food.  I am quite surprised that my calorie intake ranges from 1,200 to 1,700 per day and rarely goes above 2,000 calories.  I know that is due to dieting and I can only imagine what it was before.  I am shocked to see how much of my food is laced with sodium and carbs so I will need to work on that.

I am anxious to see what is in store for me when I see the nutritionist this week, I keep hearing stories on here about the liquid diet before and after the surgery and I hope that I can tolerate it.  I think that is why I am being so strict right now with my food as I don't want to feel as though I am "missing" something later, I want to get the mindset that I am starting "now" with my new eating lifestyle.  Well, that's all for now, just wanted to post some random thoughts!