I promised a number of pre-ops that I would outline my surgical experience, so here is the 411. Please assign all typical disclaimers, everyone's surgical experience is different, but here is mine for what its worth.
Tuesday 8/19/03: Pacific Bariatrics in San Diego, Dr. Zorn. The 19th was my pre-op class. I received and learned to use an incentive spirometer designed to promote/maintain adequate lung volume after surgery. Given the collapsed lung issues I saw in other patients, I would stress following instructions and using this device. This class also allowed me to meet some of the other patients who would be undergoing the procedure the next day--quite a friendly bunch, all open RNYers. We had all taken 3 tablespoons of milk of magnesia (as instructed) prior to the class. It was funny to see someone leap up mid sentence and run from the room in search of the bathroom. Funny that is, until it was me...
Wednesday 8/20/03: Bathed myself in Betadine in the hotel shower (a fairly humorous experience--I wonder who washes their towels?) and arrived at the Scripps Mercy Hospital at 5:30 am as instructed. I changed into a gown and then slept until 8:30 till they came to take me to pre-op. An IV was started on the first stick. I remember obligingly climbing onto the surgical table inside the operating theatre and then it was a fade to black.
I woke up in Recovery I'm told about 2 hours later. Not in much pain, as I recall. The bigger problem was that my breathing was depressed, and I kept bringing in a low oxygen alarm. So, for the next number of hours, nurses kept shaking me and telling me to breathe deeper. My assumption is that I probably have undiagnosed sleep apnea (no sleep study was required) and that every time I started to go back to sleep, my breathing would be interrupted, my O2 levels would go down, and the alarm would go off. Suffice it to say that I got no sleep in recovery. I was there about 4 to 5 hours. I'm told a 4 to 6 hour stay is average.
Then I was taken to a regular room. I had an IV with saline, a patient controlled analgesic (PCA) pain pump with morphine, a catheter, and "the black box." After I asked quite a few people, I was finally told that the black box was a time release lidocaine drip system that delivered topical pain killer directly to the incision. Must of worked--very little pain. The PCA was interesting--I got a quarter dose of morphine every time I pushed it, provided I waited 10 minutes between pushes. 10 pushes in 2 minutes didn't work. Seriously, though, I wasn't in a great deal of pain. No staples, either, thank goodness. I was glued together which worked great in my opinion.
Then I got the compression booties put on. Doesn't hurt--the booties alternately compress each foot. Keeps your circulation up and helps with avoiding blood clots. I found them quite annoying though--noisy, and they limit movement.
The nurses got me up to walk about an hour later. Me, the IV, the catheter, and the black bag. Quite a sight we made. You would think the catheter would make walking difficult, but frankly I barely noticed it. I didn't have any drains, no NG tubes, nada. In fact, whatever leak tests they may do, they did it while I was still asleep. Nothing invasive happened to me once I woke up. Darn good thing too, cause I certainly wasn't in the mood.
The IV delivers 100-150cc of liquid an hour, so I wasn't thirsty. However, the morphine gave me the worst cotton mouth ever. Kind of like a 60's flashback.
The first night was rough, but largely because of the same problem--I kept running out of air. I strongly encourage those of you who escape a sleep study, but may indeed have obstructive apnea, to consider this possible repercussion. Those with CPAP machines were just fine. I was the one awake and looking for air. Bad advance call on my part--and I had been foolishly congratulating myself on not being required to do a sleep study.
Thursday 8/21/03 "First day" postop. The catheter came out (no pain.) I was switched to Demerol because the Morphine was causing a rash. My incision was about 11" long (whoever told me 6 inches fibbed a little.) I was ordered out to walk the hallways at least five times a day. I refused to attend the mandatory exercise class--watching first day post ops throw up while they wave their arms in little circles is not my idea of a good time. The issue for day 1 post op was nausea. Yuck. I had a couple of injections of phenergan for nausea, but it didn't do much. I whined a lot which endeared me to absolutely no one.
"Second Day" postop. Still nauseous, but now have to take myself to the bathroom since I don't have a catheter. This would have been fine except for the darn booties which don't come off easily without help. The patient load for the night crew is heavy and sometimes they can't come right away when I rang. At one point, I stood up and stepped on the booties to rip them off, given that the option was to wet the bed. Well, at least I didn't have to see the booties again. I was also grumpy from lack of sleep--the interruptions for vitals, for new saline, for antacid injections into the IV, for heparin shots (blood thinners) seemed endless. Oh, and the heparin shots don't hurt either. They leave a cool bruise, but they don't hurt.
"Third Day" postop. No nausea, thank goodness, but screaming headaches. I figured it was the Demerol and stopped using it. So I had no more pain medication from about midnight of the second day. I didn't miss it. I DO NOT have a high pain tolerance--actually, I'm rather a wuss--but it just didn't hurt that bad. Today I went to the mandatory exercise class. There were a couple "First Days" there. I was right; watching them puke was not entertaining. My bandages came off and the Black Bag came off too--I was told it had been empty for quite some time. I got a couple shots of Imitrex for the headaches and a few Tylenol suppositories. (By the way, the latter is not the way to make new friends.)
I was getting the hang of taking myself for a walk or to the bathroom. You just need to plug in the IV where you reach it and work at not getting all the various tubes tangled.
I was offered and jumped at the chance of a shower. They detach parts of the IV and wrap your arm in Saran Wrap (quite high tech.) Of course, the manipulation screwed up the IV and I had to get stuck again. Im eating ice chips, SF jello, some juice. And I actually completed the "cycle"--you know, where something goes in your mouth, and something eventually comes out your intestinal tract? My Doctor gave me a round of applause. I would have gone home today if it weren't for the headache.
"Fourth Day" post op. Home! Well, back to a nearby hotel at any rate. No nausea, still have a headache, but that went away two days later. Met with other post-ops staying at the hotel for SF popsicles by the pool.
Skinny on my neighbors/roommates: (no names.) 1.) 14th day in hospital. Had had calf pain (possible blood clot) on the 3rd day and was on a course of blood thinners. 2.) 14th day in the hospital--had been released, but bounced back with a large internal hematoma requiring two drains. 3.) Released, but bounced back with a partially collapsed lung. 4.) The other three went home on their third and fourth days with no complications.
"Seventh Day" postop. Had my followup consultation with my surgeon and he released me to go home. Feel great, don't need any pain meds still. Incision is healing cleanly, and nothing particularly hurts.
"Sixteenth Day" postop (Today!) Still feeling fine, doing mostly liquids, but tried a bit of SF pudding which went down fine. Went back to work three days ago (easy--I have a desk job.) I've lost 21 pounds since they weighed me as a preop on 8/19.
Well, thats it. I hope it was not too boring for those of you who have gone through it, and informative for those who have yet to cross the bridge. Pacific Bariatrics did a great job in my opinion, and my surgeon was first rate.
