Re: Re: I can't stand the wait!/Machelle

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In a message dated 2/11/01 3:59:38 AM, duodenalswitch writes:

<< Machelle my suggestion is to sit back and revel in your last days of

enjoying more than 2 ounces of food at a meal. Also appreciate the

fact that you're not constantly nauseaus and vomiting everything you

put in your mouth. Be glad that everything you smell doesn't make you

want to heave. Be relieved that gas pain is not doubling you over in

excrutiating pain. Thank God that right now that you can take in

enough fluids that you're not in danger of becoming dehydrated. Be

happy that you're not spending your days in the bathroom with rampant

diarrhea. These are just the standard, run-of-the-mill, side effects

of a normal BPD/DS recouperation.

Yes I'm being the voice of negativity right now, but if Rabkin hasn't

told you, recovery from the BPD/DS can be particularly rough. You may

have a smooth as silk recouperation, but you may also encounter

problems or complications that can make your life hell for weeks or

months on end.

>>

Machelle: Bridget is definately correct that no one can predict

what kind of recovery they will experience. All you can do is try to prepare

yourself as much as possible and hope for the best/surround yourself with

prayer (if you are of any particular religion) and/or supporting friends!

I know that many have posted here with problems -- ranging from severe

complications to rather mild (in comparision) effects like frequent diahhrea,

nausea, etc. However, I must say that my personal experience has been

exactly opposite.

I must also add that Bridget did experience severe complications (a leak with

necrotic tissue) that necessitated a second, open operation which involved

removal of part of her intestines. Her recovery experience is by no means

the normal experience of a BPD/DS patient. I must also add that my

experience, with lack of negative problems is also NOT typical, either. I

think some nausea and/or diahhrea/gas is pretty common in the first month or

so after the surgery. I think that people may have aversion to dairy

products initially (this may not be lactose intolerance in the true sense,

since they may be able to eat dairy further down the road, but they have an

initial inability to process the dairy properly). Many have said that they

cannot drink water immediately post-op, that it's too 'heavy'. Soreness

immediately after the surgery and within the first few weeks is to be

expected (moreso with an open surgery) and it will be difficult to get

around, get up, etc. but it's important to walk as much as you can to get

circulation going and get your bowels regulated.

I had laparoscopic BPD/DS with gallbladder removal on Thursday evening,

January 25. I was discharged in three days, was up and about the day after

surgery (which really, really helped -- walking the halls and such)... was

taking my own shower on Saturday (when my surgery was the previous Thursday).

I am not in any way bragging nor do I know WHY I have not experienced the

negative side effects others have, but I have to voice my experience as well

so you know the entire spectrum of what to expect.

I was able to sleep on my side (with the help of pain meds - viocodan and a

body pillow) the first day I was home (although it was difficult to find a

comfortable position at first). This is with a laparoscopic surgery, not

open (I know of others with laparoscopic surgeries who felt too uncomfortable

to sleep on their sides right away, though).

I experienced nausea immediately after the surgery and asked for nausea meds

via iv about 3 times. I don't know if this helped me (in that my stomach

became calmer, etc. right after the surgery and the problem didn't become

worse) or not. I just know that I kept asking for anti-nausea meds within

the first 24 hours via iv and that worked for me.

I didn't have any nausea with liquids or foods, but did feel slightly

nauseous when I smelled my first stage 2 puree meal. I just pushed it away,

laid back for awhile and then was able to eat a few bites later. I was only

able to eat a few teaspoons of food at first, but finished an entire plain,

non-fat yogurt and bananna the second day over the course of half a day.

Looking back at my recovery in the hospital, some things stick out in my mind

as probably helping me: First, I loaded up on protein before the surgery,

especially in the week before the surgery. I ate very few carbs and lots of

meat, dairy, etc. I also ate a protein bar a day to add even more protein.

BElieve it or not, this high-protein approach actually helped me lose 7 lbs

from the time of my initial consult (Nov. 15) to the week before surgery when

I went for pre-admission testing and got weighed!

I hyper-hydrated myself before the surgery as well -- lots and lots of water

-- so much I thought I would burst. I only had liquids for about 24 hours

before the surgery (different surgeons have different policies - but with Mt.

Sinai you are not supposed to eat or drink the midnight before. I was

cautious and didn't have solids for about 24 hours before). Bob Bowers told

me that this had helped him immediately afterwards with gas, etc.

The protein and hydration were the best pieces of advice my nutritionist,

Niccole, could give me. I'm sure the extra protein consumption helped aid

and speed up healing -- it *may* have actually helped me with nausea control?

And, being super hydrated helped because I didn't become thirsty until about

24 hours after my surgery and got some ice chips to suck on.

I really focused on deep breathing techniques before and after surgery. It

hurt to breath so deeply and hold it but I know this must have assisted me

in recovery.

Also, I got up as soon as I was able and did laps around the hospital floor.

It wasn't easy and was painful at first, but every walk made me feel so much

better. Dr. Quinn and Dr. Gagner actually strongly advised I do this

because I started out with a slightly elevated fever before I did the

walking. I also used the lung therapy thing -- I tried to do 30 times/hour

(as suggested by Dr. Gagner) but probably did half that amount. LOL

ANother thing which I think really was a blessing in disguise: I got off the

morphine pain pump earlier than expected because my vein blew out and the

midnight nurse was UNABLE to reinsert it! AGH! This happened on Friday

evening, just 24 hours after the surgery. I was put on oral pain meds

(crushed Percocet), which worked fine for me. I was very afraid of becoming

nauseous with the oral pain meds, but that didn't happen. After I got off

the morphine, I realized how absolutely sleepy it had made me.

My food limit progressed to about 4 oz (three days to a week post-op) and now

I can eat about 6-8 oz at a meal. I eat three such meals a day and get a

protein-rich snack in at least once (it's difficult because I do feel so full

- but I add a protein shake or bar at least once a day and try to have that

for breakfast as well). I am 17 days post-op.

One thing that I think can actually PREVENT nausea (BEFORE it even begins) is

focus on PROTEIN. I now make sure I get my 75 gms/day (recommended at Mt.

Sinai for the first three weeks post-op, then it increases) in and started at

about 60 gms at three days post-op. I have to say that NOT being lactose

intolerant really helped because most of my protein sources were from dairy

(cottage cheese, cheese, yogurt). I added a protein drink and protein bars

to supplement. I think this protein consumption is essential even before the

operation and immediately post-op (of course, it's important for the rest of

one's life as a post-op DS, too).

There are no guarantees, but I think if one focuses on protein it *may* help

nausea control. At least, that has been my personal experience and others

who have added more protein have commented that it has helped them with

nausea.

I think once the nausea begins, it's a vicious cycle that is very difficult

to erradicate. I'm not sure if those who have nausea are on anti-nausea meds

like Compazine (or if those have worked for them), but I know there are some

people struggling with this side effect and it is difficult to eat anything

when the thought/smell of food makes one want to heave.

I have always had a lot of liquids and could keep water down (like it best

very cold). I was drinking too much water initially since Dr. Quinn advised

that I drink more gatorade to get essential electrolytes in and my urine was

dark-colored. So, I kept drinking gatorade in addition to water and haven't

had hydration problems other than the one time I slept in late(about day 13

post-op) and felt weak, dizzy and sweaty. I went for 14 hours without eating

or drinking anything.

Believe me, that miserable experience got me to realize I HAD to keep water

by my bedside, step up the intake of Gatorade (there are so many flavors now,

you may have to try a few before you find one you like). I ate a protein bar

and loaded up on protein and felt much better by the evening.

As far as bowels are concerned, mine are loose and mustard-colored. I was

having about 2 movements/day (in the early a.m. and then the a.m. upon

waking). In the past two days I've had more frequent night bms, most likely

because I've been experimenting with stuff: balogna and cheese sandwich,

curry Thai spring rolls (with small, finely diced pork and chicken), Indian

aloo paratha stuffed bread (with spices). They all went down fine, but I've

noticed more diahharea in the early morning hours as a result. I don't

have loose stools throughout the day, mainly at night before bed and in the

early a.m.

My bms honestly do not smell so bad -- nor does my gas. I have times where

I'm passing a lot but it passes and then I'm fine. I'm not saying that I

smell like a rose, but it isn't so outrageously stinky. I've been walking

every day -- 6 blocks and first and now up to 8 blocks or more (this is

something I did frequently before the surgery, though). I think that walking

also helps regulate the bowels and it certainly helped get them moving along

when I was in the hospital. I had my first bm about 48 hours after the

surgery.

I have experienced some gas pain pressure in my stomach and back (up to my

shoulders) in the first week, especially when eating broccoli, cucumbers and

tuna. However, I don't have much gas when I eat now even though my stomach

will become a little bloated. I burp a lot (always have after the surgery),

so maybe the burping also helps release gas pressure.

I am in no means critiquing anyone else who has experienced problems --- They

could very well have done exactly what I did and experienced negative side

effects regardless. I'm just giving all pre-ops advice based on my

experience and hoping that it will work for them, too!

A little background: I'm 35 and have never had any previous abdominal

surgeries. I didn't have any H-pylori or any previous problems with ulcers

or acid. My BMI was 45 going into the surgery (it was a little over 45

before I lost the 7 lbs). I was pretty fit and walked almost daily. I

didn't have any serious pre-existing co-morbidities except a small hiatus

hernia/mild GERD (diagnosed during my endoscopy) as well as back/joint pain,

lack of energy, IBS/Spastic colon and abdominal pains caused in part by HUGE

gallstones. The only meds I took pre-op were Paxil (for General Anxiety

Disorder) and anti-spasmodic meds for the spastic colon on occassion. I'm

sure these factors also contributed to recovery, etc. to some degree.

I can say that, having IBS and experienced extreme pain/gas before the

surgery, my situation is 110 pct better post-op! I have more energy and

don't have the annoying nauseous feeling and sharp pains now that my

gallbladder is out and the intestines are re-arranged with the BPD/DS.

EAch person is individual and there are a complex series of interacting

factors that play out that can affect one's recovery. There are those who

faced extreme difficulty/complications, those who haven't really had any

problems post-op and the majority, I think, are in between -- they may

experience gas, nausea, frequent bm's but not to any overwhelmingly

dehabilitating degree.

I wish you the best for your surgery --- I hope that my experience can help

in any way to assist you in preparing as best as you can for an uneventful

recovery. I wouldn't discount prayer at all, either. I realize not everyone

is necessarily Christian here, but I definately know I wouldn't be where I am

today without so many people's thoughts and prayers.

all the best,

laparoscopic BPD/DS with gallbladder removal

Dr. Gagner/Dr. Quinn assisting, Mt. Sinai/NYC

January 25, 2001

17 days post-op and feelin' fab!