Sunday, May 15, 2016

Indefinite Blog Hiatus After Surgery

Table for solid-liquid fasting in Preparation for Surgery brochure (p. 5). Times in last column are those required before actual surgery is performed.

As I had reported at the end of March, e.g.

a severe gall bladder attack had sent me to the ER where I spent several hours receiving medical assistance, pain relievers and having tests. The outcome of the visit was clear: I needed to have my gall bladder removed as leaving it in increased the risk of liver damage (jaundice) as well as cancer of the gall bladder. Not to mention even more painful future gall stone attacks - especially if a small stone became lodged in the common bile duct- possibly leading to pancreatitis.

Following the events of that early morning I had a surgical consult several days later and though the surgeon worried about our going off for three weeks to Barbados (and having a critical attack there) I vowed to adhere to a plan of "virtuous eating".  This I largely did except for one lunch where I ate a (fried) flying fish cutter leading to some rapid consequences in the form of diarrhea.

After that, no more fried anything, just baked chicken and fish. And chicken hot dogs with hard boiled eggs for breakfast (no bacon, or greasy cooked eggs).

Now, it's "show time" and I had the pre-operative visit on Thursday which lasted three hours while I filled out endless forms as well as having an EKG and blood tests (CBC, Lipid panel) . I also had to answer numerous questions from a Nurse from everything to the allergies I had (especially to drugs) and also any breathing problems (sleep apnea? lung issues?) and any history of illness, medications -supplements taken (I was somewhat embarrassed to provide my list of 18 supplements)

I was then given instructions, including how to prepare pre-operatively using a special skin cleanser (CHG or chlorhexidine gluconate)  to reduce the risk of infection. See e.g.

There were also "fasting" instructions, though I had to laugh at the divergence in advice from the hospital's own pamphlets: one insisting "nothing after midnight" (including water!), while the surgical prep brochure allowed liquids up to 6 hours before surgery (meaning I could have a nice drink at 4:00 a.m.) and the anesthesiologist's brochure allowing clear liquids 4 hours before. Why such divergence? Who knows? But in various papers I've read it appears the 12 midnight rule is now passe, it's just that too many medical centers haven't caught up. One medical paper actually said patients could drink up to 150 ml two hours before and in fact, it "led to less dehydration and lower stomach gastric juices." (It is reflux of gastric juices as a reaction to anesthesia that can cause what is called aspiration and lead to pneumonia)

But the original research leading to the "Nil  pre-op" (NPO) rule actually came from the 1950s when a study showed pregnant women aspirating (under an ether mask) after having taken liquids some hours before. What if physicists didn't update their data since the 1950s?

Anyway, the surgery - technically called a “Laparoscopic Cholecystectomy" is scheduled for Monday at 10 a.m. The actual operation, shown as an animated, instructional video (for med residents)  can be viewed here:

 It is usually over in an hour or so, then another hour is spent in what they call the PACU or "post anesthesia care unit" where you have to remain until you can: a) wake up and sound coherent, b) eat and drink something, and c) urinate.  You are also administered pain medications but generally not so much that they delay your coming out of the anesthesia.

The issue of post-operative recovery then emerges and that includes taking care of the wounds so they don't get infected, and also managing the pain. Evidently, from what I've read, the post surgical pain can vary widely. A friend of mine had the same procedure in North Carolina 3 months ago and according to him, just got up and walked out after an hour. Others don't fare so well, and some patient sites have reported pain even months or years later.

Bottom line the level of pain and discomfort - as well as side effects of pain relievers (i.e. most cause me to sleep, like ibuprofen) will determine when the next blog post appears.

Not to worry, there remain  a lot of less-read posts and these should keep site visitors occupied for a while.


Ahab said...

Take all the time you need to recover, Copernicus. I hope your recovery is a smooth one.

Copernicus said...

Thanks! Main issue now is not so much the pain (about a 1.5 out of 10) but stopping the bleeding from the abdominal incision (shown below the belly button in the video). So can't stay vertical too long or even sitting up lest the bleeding (most of it oozing from the wound) recur. Had to call the surgeon last night on getting advice and he said to apply pressure when it occurs, first 5 minutes, then 10. So far its holding but net 2-3 days will determine ease of entry to regular activities.