Re: Laproscopic Adrenalectomy Post-Surgical Expectations??

December 9, 2006

I had three tubes (endoscope, cutter and healer), and had no

restrictions imposed by the surgeon after 10 days. Before that,

commonsensical testing prevailed - if it hurt, I put it off. Walking

exercise with stretching helped speed recovery, as did good diet,

lighter than usual (less crowding, gas or expansion) of whole foods. I

used a digestive enzyme (beano, in that time) prior to eating. Left

out the processed sugars and heavy fat protein items for awhile. Air

travel was a two-week restriction, but again, healing times vary. The

followup visits will guide the surgeon.

The painkillers with a narcotic (e.g. codeine) usually disrupt sleep,

so getting to straight tylenol and then nothing at all was a goal.

Those also cause or exacerbate constipation, with the already mentioned

expansion problems. So I used ducolax too, as common post-op Rx

because surgery is catabolic. Later I found that prune juice with pulp

is probably better. Two subsequent surgeries proved it so for me.

Maybe some of both on-hand would be wise.

Toradol is a painkiller specifically developed for abdomen and

lower-body pain, but it does interfere with the urinary tract in some

pts. I found it more effective than any other after the adrenalectomy.

They give it IV in the hospital, but I had to ask via my family. The

ketorolac pill too was a special request.

Dave

On Dec 9, 2006, at 2:23 PM, datawrhsdoc wrote:

> Folks,

>

> I'm having my left adrenal out on Monday. I have an idea of what the

> recovery will be like based on all the messages on the group

> (Thanks!!), but I neglected to ask my surgeon what post-surgical

> restrictions will be. Anyone still have a copy or memory of their

> post-surgical instructions?

>

> Mostly, I'm interested in things like when it should be OK to walk up

> steps, drive, fly in a commercial aircraft (thinking about trapped

> gas), and lift objects more than a couple pounds.

>

> Thanks,

> Jeff

>

December 9, 2006

Dave,Thanks for the feedback...as well as the tips! I'll be stocking up on the Beano, Ducolax, prune juice, and Tylenol tomorrow and will ask my surgeon about the Toradol.Regards,Jeff

On 12/9/06, Uncle Dave <riothamus20@...> wrote:

I had three tubes (endoscope, cutter and healer), and had norestrictions imposed by the surgeon after 10 days. Before that,commonsensical testing prevailed - if it hurt, I put it off. Walkingexercise with stretching helped speed recovery, as did good diet,

lighter than usual (less crowding, gas or expansion) of whole foods. Iused a digestive enzyme (beano, in that time) prior to eating. Leftout the processed sugars and heavy fat protein items for awhile. Air

travel was a two-week restriction, but again, healing times vary. Thefollowup visits will guide the surgeon.The painkillers with a narcotic (e.g. codeine) usually disrupt sleep,so getting to straight tylenol and then nothing at all was a goal.

Those also cause or exacerbate constipation, with the already mentionedexpansion problems. So I used ducolax too, as common post-op Rxbecause surgery is catabolic. Later I found that prune juice with pulp

is probably better. Two subsequent surgeries proved it so for me.Maybe some of both on-hand would be wise.Toradol is a painkiller specifically developed for abdomen andlower-body pain, but it does interfere with the urinary tract in some

pts. I found it more effective than any other after the adrenalectomy. They give it IV in the hospital, but I had to ask via my family. Theketorolac pill too was a special request.DaveOn Dec 9, 2006, at 2:23 PM, datawrhsdoc wrote:

> Folks,>> I'm having my left adrenal out on Monday. I have an idea of what the> recovery will be like based on all the messages on the group> (Thanks!!), but I neglected to ask my surgeon what post-surgical

> restrictions will be. Anyone still have a copy or memory of their> post-surgical instructions?>> Mostly, I'm interested in things like when it should be OK to walk up> steps, drive, fly in a commercial aircraft (thinking about trapped

> gas), and lift objects more than a couple pounds.>> Thanks,> Jeff>

December 9, 2006

You're welcome, Jeff. I'm sure there are things I don't know - it's

been 6 years. We of the three bullet-holes must stick together.

;^)

Dave

On Dec 9, 2006, at 7:47 PM, Jeff Feinsmith wrote:

> Dave,

>

> Thanks for the feedback...as well as the tips! I'll be stocking up on

> the Beano, Ducolax, prune juice, and Tylenol tomorrow and will ask my

> surgeon about the Toradol.

>

> Regards,

> Jeff

>

> On 12/9/06, Uncle Dave <riothamus20@...> wrote:

>> restrictions imposed by the surgeon after 10 days. Before that,

>> commonsensical testing prevailed - if it hurt, I put it off. Walking

>> exercise with stretching helped speed recovery, as did good diet,

>> lighter than usual (less crowding, gas or expansion) of whole

>> foods. I

>> used a digestive enzyme (beano, in that time) prior to eating. Left

>> out the processed sugars and heavy fat protein items for awhile. Air

>> travel was a two-week restriction, but again, healing times vary. The

>> followup visits will guide the surgeon.

>>

>> The painkillers with a narcotic (e.g. codeine) usually disrupt sleep,

>> so getting to straight tylenol and then nothing at all was a goal.

>> Those also cause or exacerbate constipation, with the already

>> mentioned

>> expansion problems. So I used ducolax too, as common post-op Rx

>> because surgery is catabolic. Later I found that prune juice with

>> pulp

>> is probably better. Two subsequent surgeries proved it so for me.

>> Maybe some of both on-hand would be wise.

>>

>> Toradol is a painkiller specifically developed for abdomen and

>> lower-body pain, but it does interfere with the urinary tract in some

>> pts. I found it more effective than any other after the

>> adrenalectomy.

>> They give it IV in the hospital, but I had to ask via my

>> family. The

>> ketorolac pill too was a special request.

>>

>> Dave

>>

>> On Dec 9, 2006, at 2:23 PM, datawrhsdoc wrote:

>>

>> > Folks,

>> >

>> > I'm having my left adrenal out on Monday. I have an idea of what

>> the

>> > recovery will be like based on all the messages on the group

>> > (Thanks!!), but I neglected to ask my surgeon what post-surgical

>> > restrictions will be. Anyone still have a copy or memory of their

>> > post-surgical instructions?

>> >

>> > Mostly, I'm interested in things like when it should be OK to walk

>> up

>> > steps, drive, fly in a commercial aircraft (thinking about trapped

>> > gas), and lift objects more than a couple pounds.

>> >

>> > Thanks,

>> > Jeff

>> >

December 10, 2006

Maybe you could copy the instructions you get and we can put them in our files if they look good.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

December 10, 2006

Dr. Grim,I certainly will...at least if I'm not in too much pain to remember to do it.-JeffOn 12/10/06, lowerbp2@...

<lowerbp2@...> wrote:

Maybe you could copy the instructions you get and we can put them in our files if they look good.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

December 12, 2006

Dr. Grim,

I'm back home now. They took the left adrenal out yesterday

afternoon, and I'm feeling surprisingly good. There really hasn't

been any pain that a Tylenol or two can't completely surpress. In

fact, at the moment, less than 24hrs after my surgery, I have no pain

whatsoever...just a bit of bloating and tightness in the left side of

my abdomen.

Interestingly, unlike Uncle Dave and some of the others on the group,

I don't have three holes. Instead, I've got four! The pattern makes

it look like someone plugged me with a semi-automatic pistol.

As to the post-op instructions, they were pretty much the usual for a

minor surgical procedure. Rest as needed, consume lots of fluids, no

driving for 24 hours, watch out for signs of infection, 2 weeks of not

lifting anything heavier than 20 lbs, showering but no

bathing/immersion, and follow-up with surgeon in 1-2 weeks. The

instructions don't mention anything about air travel, and I forgot to ask.

Regards,

Jeff

>

> Maybe you could copy the instructions you get and we can put them in

our

> files if they look good.

>

December 13, 2006

Jeff

I also have " four holes " from my surgery.

Received just about the same instructions as you did

but I was told could take up to six weeks to heal

completely. I had abdominal muscle pain for about 4

1/2 weeks but nothing that one Tylenol twice a day

couldn't fix. The left sided bloating also took about

4 weeks to resolve. I felt it was inflammatory and did

some gentle stretching exercises to relieve the

discomfort (Yoga). I was told by the surgeon not to

resume my abdominal strenghening exercises for 6

weeks.

I also have the added complication of being female

with all those raging hormones, I skipped one cycle

but it is back this month same as ever with some minor

back discomfort but not all the cramping I had before.

Otherwise my energy level is great and I have no

muscle discomfort from exercise like before. Did all

day Christmas shopping yesterday with no bad after

effects except an empty wallet. Couldn't do that

before surgery.

I blame the low potassium levels for most of the

cramping and headaches I was having as they are gone

now. When will they check your electrolytes again?

Hope you continue to feel well and enjoy the Holiday

Season.

________________________________________________________________________________\

____

Any questions? Get answers on any topic at www.Answers.. Try it now.

December 13, 2006

,

Yes, I've got the swelling as well. It was a bit of a shock when

stepped on the scale yesterday afternoon 11 lbs heavier than Sunday.

It helped a bit that I dumped about 5 pounds of post-op fluid buildup

last night, but I've still got about 5-6 lbs of extra fluid associated

with swelling. That's definitely going to take a while to resolve.

I'll certainly try the yoga stretching exercises.

I plan to see my endocrinologist on the 29th, when I get back from

Christmas holiday, but will likely get my electrolytes checked during

my follow-up with the surgeon on the 21st.

Regards,

Jeff

>

> Jeff

>

> I also have " four holes " from my surgery.

>

> Received just about the same instructions as you did

> but I was told could take up to six weeks to heal

> completely. I had abdominal muscle pain for about 4

> 1/2 weeks but nothing that one Tylenol twice a day

> couldn't fix. The left sided bloating also took about

> 4 weeks to resolve. I felt it was inflammatory and did

> some gentle stretching exercises to relieve the

> discomfort (Yoga). I was told by the surgeon not to

> resume my abdominal strenghening exercises for 6

> weeks.

>

> I also have the added complication of being female

> with all those raging hormones, I skipped one cycle

> but it is back this month same as ever with some minor

> back discomfort but not all the cramping I had before.

> Otherwise my energy level is great and I have no

> muscle discomfort from exercise like before. Did all

> day Christmas shopping yesterday with no bad after

> effects except an empty wallet. Couldn't do that

> before surgery.

>

> I blame the low potassium levels for most of the

> cramping and headaches I was having as they are gone

> now. When will they check your electrolytes again?

>

> Hope you continue to feel well and enjoy the Holiday

> Season.

>

________________________________________________________________________________\

____

> Any questions? Get answers on any topic at www.Answers..

Try it now.

>

December 14, 2006

In a message dated 12/12/06 2:52:24 PM, jfeinsmith@... writes:

Dr. Grim,

I'm back home now. They took the left adrenal out yesterday

afternoon, and I'm feeling surprisingly good. There really hasn't

been any pain that a Tylenol or two can't completely surpress. In

fact, at the moment, less than 24hrs after my surgery, I have no pain

whatsoever.. whatsoever..<wbr>.just a bit of bloating and tightness i

my abdomen.

Interestingly, unlike Uncle Dave and some of the others on the group,

I don't have three holes. Instead, I've got four! The pattern makes

it look like someone plugged me with a semi-automatic pistol.

As to the post-op instructions, they were pretty much the usual for a

minor surgical procedure. Rest as needed, consume lots of fluids, no

driving for 24 hours, watch out for signs of infection, 2 weeks of not

lifting anything heavier than 20 lbs, showering but no

bathing/immersion, and follow-up with surgeon in 1-2 weeks. The

instructions don't mention anything about air travel, and I forgot to ask.

Regards,

Jeff

>

> Maybe you could copy the instructions you get and we can put them in

our

> files if they look good.

>

Excellent-keep us posted.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

December 14, 2006

In a message dated 12/13/06 2:29:09 PM, shotzie@... writes:

I blame the low potassium levels for most of the

cramping and headaches I was having as they are gone

now. When will they check your electrolytes again?

Congrats on getting the right diagnosis and RX.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

December 18, 2006

In a message dated 12/18/06 4:49:37 PM, jfeinsmith@... writes:

The

surgeon shoves the organ into a special baggie and pulls the baggie

through the larger 4th hole which is about 3 or 4 cm in size.

This is one reason the adrenal looks like a piece of hamburer when it comes out so tissue study may be messed up. Ask them to try to get it out whole and not all messed up so the pathology can be well studied.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

December 18, 2006

dave,

what is a " three bullet-hole " ?

david 2

> >>

> >> > Folks,

> >> >

> >> > I'm having my left adrenal out on Monday. I have an idea of what

> >> the

> >> > recovery will be like based on all the messages on the group

> >> > (Thanks!!), but I neglected to ask my surgeon what post-surgical

> >> > restrictions will be. Anyone still have a copy or memory of their

> >> > post-surgical instructions?

> >> >

> >> > Mostly, I'm interested in things like when it should be OK to

walk

> >> up

> >> > steps, drive, fly in a commercial aircraft (thinking about trapped

> >> > gas), and lift objects more than a couple pounds.

> >> >

> >> > Thanks,

> >> > Jeff

> >> >

>

December 18, 2006

Dave is referring to the rather small incision scars from surgery.

They look somewhat like bullet wounds once they scar over. I've got

4. 3 are about 1cm in size for the instruments and cameras. The

surgeon shoves the organ into a special baggie and pulls the baggie

through the larger 4th hole which is about 3 or 4 cm in size.

Some of us have 3 bullet-holes and some have 4. It generally depends

on whether 1 surgeon or 2 are performing the procedure. The second

surgeon uses the extra port.

-Jeff

>

> dave,

>

> what is a " three bullet-hole " ?

>

> david 2

>

December 18, 2006

Three laporoscopic insertions - many get four.

Dave

On Dec 18, 2006, at 2:01 PM, bayabas76 wrote:

> dave,

>

> what is a " three bullet-hole " ?

>

> david 2

>

> > >>

> > >> > Folks,

> > >> >

> > >> > I'm having my left adrenal out on Monday. I have an idea of

> what

> > >> the

> > >> > recovery will be like based on all the messages on the group

> > >> > (Thanks!!), but I neglected to ask my surgeon what

> post-surgical

> > >> > restrictions will be. Anyone still have a copy or memory of

> their

> > >> > post-surgical instructions?

> > >> >

> > >> > Mostly, I'm interested in things like when it should be OK to

> walk

> > >> up

> > >> > steps, drive, fly in a commercial aircraft (thinking about

> trapped

> > >> > gas), and lift objects more than a couple pounds.

> > >> >

> > >> > Thanks,

> > >> > Jeff

> > >> >

>

December 18, 2006

Dr. Grim,

I think in my case the surgeon spent a great deal of extra time (4

hours in OR) to get the organ out intact as well as identify the mass.

Based on the pathology findings which described specific location of

the adenoma, cellular makeup, borders, and description of the rest of

the gland, I am certain pathology didn't get a lump of " hamburger meat. "

That said, if someone must use a surgeon that has not done many of

these procedures, the patient should be very clear about their

expectation that an intact gland be removed and sent to pathology.

By the way, be sure to add to your MD list the follow physicians:

Dr. Gordon Wotton (endocrinologist)

5667 Peachtree Dunwoody Rd, Suite 150

Atlanta, GA 30342

(404) 256-6281

Dr. Iqbal Garcha (surgeon)

5670 Peachtree Dunwoody Rd, Suite 920

Atlanta, GA 30342

(404) 250-1694

Regards,

Jeff

>

> In a message dated 12/18/06 4:49:37 PM, jfeinsmith@... writes:

>

> > The

> > surgeon shoves the organ into a special baggie and pulls the baggie

> > through the larger 4th hole which is about 3 or 4 cm in size.

> >

>

> This is one reason the adrenal looks like a piece of hamburer when

it comes

> out so tissue study may be messed up. Ask them to try to get it

out whole and

> not all messed up so the pathology can be well studied.

>

> May your pressure be low!

>

> Clarence E. Grim, B.S., M.S., M.D.

> Specializing in Difficult to Control High Blood Pressure

> and the Physiology and History of Survival During

> Hard Times and Heart Disease today.

>

December 18, 2006

Good what did the pathology show in detail or do you know yet? I dont recall.

May your pressure be low!

Clarence E. Grim, B.S., M.S., M.D.

Specializing in Difficult to Control High Blood Pressure

and the Physiology and History of Survival During

Hard Times and Heart Disease today.

December 18, 2006

Oops. I gave you fax numbers. The correct numbers are:

Wotton: (404) 256-0775

Garcha: (404) 847-0664

-Jeff

On 12/18/06, datawrhsdoc <jfeinsmith@...> wrote:

> Dr. Grim,

>

> I think in my case the surgeon spent a great deal of extra time (4

> hours in OR) to get the organ out intact as well as identify the mass.

> Based on the pathology findings which described specific location of

> the adenoma, cellular makeup, borders, and description of the rest of

> the gland, I am certain pathology didn't get a lump of " hamburger meat. "

>

> That said, if someone must use a surgeon that has not done many of

> these procedures, the patient should be very clear about their

> expectation that an intact gland be removed and sent to pathology.

>

> By the way, be sure to add to your MD list the follow physicians:

>

> Dr. Gordon Wotton (endocrinologist)

> 5667 Peachtree Dunwoody Rd, Suite 150

> Atlanta, GA 30342

> (404) 256-6281

>

> Dr. Iqbal Garcha (surgeon)

> 5670 Peachtree Dunwoody Rd, Suite 920

> Atlanta, GA 30342

> (404) 250-1694

>

> Regards,

> Jeff

>

> >

> > In a message dated 12/18/06 4:49:37 PM, jfeinsmith@... writes:

> >

> > > The

> > > surgeon shoves the organ into a special baggie and pulls the baggie

> > > through the larger 4th hole which is about 3 or 4 cm in size.

> > >

> >

> > This is one reason the adrenal looks like a piece of hamburer when

> it comes

> > out so tissue study may be messed up. Ask them to try to get it

> out whole and

> > not all messed up so the pathology can be well studied.

> >

> > May your pressure be low!

> >

> > Clarence E. Grim, B.S., M.S., M.D.

> > Specializing in Difficult to Control High Blood Pressure

> > and the Physiology and History of Survival During

> > Hard Times and Heart Disease today.

> >

>

December 19, 2006

Dr. Grim,

Here you go. Based on my post-surgical BP's (120/80 or below),

evidence is that the adenoma was functional in nature. If I'm reading

the path report correctly, there was no indication of carcinoma nor

pre-cancerous cellular changes, correct? Spelling errors are mine

Thanks,

Jeff

Final Pathologic Diagnosis

--------------------------

Adrenal gland, left, adrenalectomy: Adrenal Cortical Adenoma (1.2cm),

Margins Not Involved

Clinical History

----------------

Left adrenal mass

Specimen Received

-----------------

Left adrenal gland

Gross Desc

----------

The specimen received is one part labeled 'left adrenal gland, [pt

name]. Received in formalin is an adrenal gland with attached

yellow-golden lobulated fatty tissue 19gms and measuring 7.2 x 2.4 x

2.0 cm. The specimen is entirely inked black and serially sectioned

to reveal a well circumscribed grey-tan to orange mass which measures

1.2 x 0.8 x 0.5 cm. This mass does grossly appear to abut the black

inked soft tissue margin. The remaining cut surfaces are orange-brown

and the cortimedullary junction is well defined. Representative

sections are submitted as follows:

etc.

Microscopic Definition

----------------------

Sections demonstrate a well-demarcated tumor nodule in the cortex with

a smooth pushing border. The lesion is composed of broad fields of

pale staining, lipid rich cells with relatively uniform nuclei and

cytoplasm that appears finely vascuolated. The lesion is composed of

admixture of patterns including nesting/alveclar arrangement, short

cords, and narrow interconnecting trabeculae. The tumor nuclei are

single and round to oval with margination of chromatin along the

nuclear membrane. Some nuclei contain single duct-like nucleus.

Significant cytologic atypia or mitotic figures is not appreciated.

Overall these findings are most in keeping with an adrenal cortical

adenoma.

>

> Good what did the pathology show in detail or do you know yet? I dont

> recall.

>

> May your pressure be low!

>

> Clarence E. Grim, B.S., M.S., M.D.

> Specializing in Difficult to Control High Blood Pressure

> and the Physiology and History of Survival During

> Hard Times and Heart Disease today.

>

December 19, 2006