pain medication infusion pump, drains and amount of skin and fat removal

Hi Dr. Lomonaco, thanks for your continued efforts on educating us via your web site and your responses on this forum.

I am scheduled for a Panniculectomy with anchor cut this coming Monday. I had my preop meeting with my surgeon and my general practitioner this past week. I discussed with both of them the concerns I have with pain post op and the possible use of an analgesic infusion pump. The surgeon told that she would gladly use one but that based on the type of surgery, my pain would be well controlled with oral meds. The only negative aspect that she brought up around using a pump was the fact that in addition to the two drains there would be another thing I would have to worry about managing. The procedure will not involve any muscle work unless she finds a hernia (I haven't had any symptoms of having one). I don't feel that managing the two drains and the pump will be an issue and I would like to have the extra insurance on this. I noticed also that these pumps are available in different configurations like with a preset setting, with an adjustable setting and an on demand settings, what are your thoughts on first of all using the pump for my procedure and the type of pump to use? Do you use the On Q pump? Would you use this on a panniculectomy wuth anchor cut procedure? These pumps have the capacity to hold analgisic for 3 to 5 days, how long do you feel is ideal to use the pump for?

I use to weight about 408 pounds and are down to 220 with most of my issues being around my abdomen, there is a substantial pannus which I am sure is made of skin and fat. How does a surgeon decide how much fat and tissue they can safely remove when doing this procedure?

I also have a question on the type of drains you use, the brands I have seen are Jackson Pratt and Blake Silicon Drains, Blake claims passion confort and more patency on the drains, what do you use?

I had so many questions during my pre op visit that I really failed to discuss this last issue. I appreciate you input on these topics.

Thanks for your help

I cant really be a lot of help to you... For one thing i have a high tolerence to pain.  I had a complete lower body lift with a anchor cut... Inner thigh lift,, breast lift with implants and my upper arms done on Monday the 16th.  I was in surgery for over 10 hours.   I came back to the hotel room here on Wed before noon. Since i got out of the hospital i have only taken 2 tylenol every 8 hours for about 3 days and since then nothing.    
   But every person is different
Wishing you good luck!!!

TammyLynne - Your my HERO!  I sure wish I could have done that just with my LBL.  LOL  I am having a Breast Lift and Lipo of back, side fanks and arms and I am scared to death of the pain people are saying from LIPO.

Congrats on your surgery!!

First off, I have lots of pictures of me the day of surgery, the next day and on Saturday when they changes the bandages, pictures of the wound site.  My son also took some pictures today when the home healthcare nurse changed the bandages.  If you are insterested and want to see some pictures.  I was cut from hip to hip 30-32 inches, I have about 12 inches or so on my back that isn'/wasn't cut.  86 or 87 staples.  I chose staples not sutures cause we paid cash and it takes a lot less time and I do not care about a scar.

I did not have a pump.  I was sent home with 2 drains, they are Jackson Pratt Drains and really easy to care for so do not worry about them.  I do have a home healthcare nurse coming in twice a week to change bandages.  We didn't for the DS even though I had open and ended up with an open wound trying to drain all the yuck out.  But we figured this was a huge wound and having a nurse come and check it out and do the bandages was a smart move.

My surgeon decided how much was safe once he got in, so to speak.  He said it was something he would have to do at the time, sort of a hands on feeling type of thing.  I trust my surgeon or I would not have let him do the surgery in the first place, so I trusted his judgement.

I have kept detailed records on everything.  Daily account of things and what happened.  Like when I walked, how I felt, what my pain was like.

The pain wasn't bad except twice.

1. when I first stood up (but that was expected)
2. I had what ended up being nerve pain in my shoulder.  It was the worse pain I ever felt, in my life hands down retching.  My right shoulder had the sharpest most horrific pain and it happened with every breath, short of deep.  The deeper the breath the worse it was.

My surgeon told me the diagram nerves are somehow connected with the shoulder and since I had a hernia when they got into the panniculectomy the muscles were 'messed' with and that is likely what cause the pain.  the pain was only for a few hours and it was odd.  every time I burped or hic-up'ed I felt it in my shoulder and then it would relax a bit more.

Okay, if you want to know anything let me know, I just had my panniculectomy Thursday Nov 19th so just a week ago.

Good luck!!!

-Jaime

Hi Jaime, I am glad you are doing well. I appreciate you sharing your experience and your pictures with us. Your results look great!

My daughter is a nurse and will be spending  the first two nights at home with me. My wife will also be home so I should have plenty of help.

I noticed that you are wearing your compression garment, how does this work with the drains, it seems like the drains are lower than were the compression garment ends so it will not get in the way of the tubes.

When were you able to shower? what do you do with the drains and pouches when you shower?

Is there a list of things I should have at home to deal with all of this?  So far I have a raised toilet seat, a walker, surgical tape, I purchased a 12 inch tall compressing garment since I will have a panniculectomy with an anchor cut and thought it would be good for the garment to go higher, I am sure I will get one at the hospital but thought I should have two of them anyway.

The surgeon never talked about changing dressings so I don't know what I need in order to do this. I am sure the nurses will instruct me on all of this prior to discharge, I have seen these gauze's that have a slit on them and are circular in shape, It seems that they would work well for placing them around the drains, How often do you have to change the gauze?

When is your first post op visit with the surgeon?

If you have list of things I should buy over the weekend in addition to what I have listed I would appreciate you sharing this with me. Keep us updated on your progress.

Best Wishes

First and foremost, LUCKY!!!!  I wish I had a nurse to stay with me, that would be great.  I was so worried about having someone other than my wife and myself be able to look at the wound and make sure it was not infected or anything.

After a couple of days at home I started feeling better knowing that infection wasn't setting in on the wound.  Now it has been a week and I feel much more at ease because qualified people have told me it looked good when they did the dressing change. 

My surgery was last Thursday.  Took lots of pain medication, my Dr. had me on a pump that lets me give myself pain meds every 10 minutes.  I was only on it the remainder of Thursday, Friday and took it away late Friday evening.

When I got home I had pain killers I could take 1 tab every 4 hrs or 2 tabs every 6.  the rest of Saturday, Sunday and Monday I took one tab every 4 throughout day and 2 tabs at bedtime. Tuesday I started taking the single tab every 5-6 hours, I am still taking 2 tabs at bedtime but today I have only had 2 tabs. 

The compression garment:  I have worn it 24 hours a day and not taken it off yet.  The only time it even comes undone is for a dressing change.  I will tighten/loosen it throughout the day sometimes if I start to get uncomfortable.  I also loosen it for my wife about once a day so she can see if there are any areas on the bandaging that are discolored, which would be leakage at the wound site.

Showering: No showering until the drains are out.  I guess each doctor is different but they say sponge bath only.  I have read some doctors allow for short showers but you cannot let the water run all over you like normal. 

Dressing/Bandaging:  the nurses did teach myself and my wife how to change the dressing but your daughter should be able to show your wife how.  Do not spend your money on those 'special' drainage tube bandages.  Here is what you do, take a paid of scissors and make a diagonal cut to the center of the bandage.  Here is how the hospital dressed mine.  they used this special bandage for the navel (I got a new belly button, they had too though).  The special bandage is has this slick coating on it, not Vaseline but something similar.  Just large enough to cover the navel with about an inch hanging out.  then they put the nonstick gauze everywhere, on top of the nonstick they placed the big fluffy gauze that is really good at soaking up fluid. Then they taped it and I had the compression belt.

First Post-op doctor visit:  Since my surgery was exactly a week before Thanksgiving my surgeon was out of the office from Wed. through Friday and won't be back in the office until Monday.  I made my first post-op appointment for Tuesday afternoon Dec. 1st, 12 days after surgery.  But the surgeon's office has an on-call doctor and all of their doctors are familiar with all of the gastric surgeries, because they all do them.

I look for the surgeon to remove every other staple Tuesday and maybe the drains if they are not producing much.  they were but are a fraction of what I was getting from them.  The right drain got 10 times more than the left, easily.  Both are down to only needing to be empties once a day and the left is under 20cc now.  The right drain put out about 40-50cc today.  It was putting out a few hundred cc the first few days.  Although the color has gotten a darker red in both.  the left drain was a milky red the right has looked like... red punch.  Now it looks more like grape/cherry juice.

OK here is the important things I ended up getting in the last week.

The correct bandaging, and plenty of it.  Also this stuff that is sticky when applied but make it so that the tape doesn't tear your skin up when removed.  I cannot remember what it is called but it comes in small squares, like the KFC wipes or those small alcohol wipes for single use.

I also got the costly tape, I used several kinds last year for my original surgery and my skin was so sore.  This time I only use the medipore, made by 3M.  It is expensive but well worth it. http://solutions.3m.com/wps/portal/3M/en_US/wound-care/skin/ support/product_catalog/?PC_7_RJH9U52308DL40I0NND6NR3S24_nid =46W6VGS0QJbeB385P3RT67gl

They had compression socks on me at the hospital.  I hated them and they were thin and crappy.  I went and bought a nice pair and have worn them the last 2 days and not needed to remove them.  Much better and thicker than the other ones.  Plus they don't fall down so my wife or son doesn't have to come pull them up for me, since I cannot bend over right now.

I got some of that good aloe hand sanitizer from purell (same brand and kind the hospital used) and I use it before and after I drain my drains, use bathroom, etc...  I also wash my hands for a good 20-30 seconds under water often but I also use the sanitizer just to be safe.  I also grab it and shoot people that come in the house or are going to touch me or my stuff.  Sure it is being anal but I don't want an infection due to not being clean.

I think that is about all I got post-op that you haven't already gotten.  The one thing that saved me was the toilet seat riser and the walker.  I only used the walker the first 2-3 days home and the 2nd/3rd day it was more because my back hurt so badly from sitting all the time.  My back still aches but I use a heating pad and crank it on about 20 minutes before I know I am going to get up and all is good.

Good idea about the extra compression garment.  I have the one form the hospital and I have the drain bulbs safety pinned to it, I did more them up higher so I could wear pants.  the compression garment I keep just above where the drains go into me.  My drains go in about 2 inches below the staple line.  I will say that it was really tight sometimes the first few days when I was bloated and draining and hadn't went #2.  Oh get stool softener just in case.  I have had loose stools since my DS last Oct. but this firmed them up because of all the pain medication.  I did finally go and it was nearly painless.  Thanks to the stool softeners., it was about 5 days post-op.

I did take more pictures today if you would like to see more, while the nurse was changing bandages.   That is something else that I found odd.  When they change them and they pat them when cleaning them and when they press the tape on they are doing it nicely but I cannot really feel it.  Sort of like how the dentist works on you, it eel numb.  I think it is due to the nerves being messed with.

Okay, so that was a long post.  Good luck Monday all will be fine if you do what you need to and stay clean and use common sense.  I also could not find much information.  It was disappointing.

-Jaime

Thanks for your reply Cleo. It's nice to have access to this forum. Hope your recovery continues to go well

Hi
you will come out of the OR with a compression garment but you do need a couple case you will have to wear it 24/7 and they do get soiled they have to be washed by and and DO NOT put them in the dryer.
My PS changed my dressing on my first post-op visit actually he removed the dressings and just left the steri strips to fall off when I showered. I didn't need to use any other gauze pads, but then my PS doesn't use staples to close the incison he sewed from the inside and used steri strips on the outside. I never used anything around the drains.
my first post-op visit was 5 days post-op,
1.I had a TT with muscle tightening & Hysterectomy12/12/08 - no problems no pain from surgery my back hurt from having to walk bent over
2.inner thigh , back & butt lift 3/30/09 = no problems thighs hurt for the first  3 days real bad
3. arms.eyelids and lipo 11/23/09 - no problems yet, the eyes hurt more then the arms cause you always blink, otherwise OK

I don't use Narcotics for pain cause they make me very nauseous and constipated, very woozy, my first day home I always take tylenol to take the edge off any pain and just in case I get a fever.

Well when you shower and you still ave the drains in I tied a string around my neck and attached the drains to the string.

my drains came out the bottom of  my compression garment and I attached them to the upper part of the garment and they drained fine, that is how they had them when I came out of the OR.
Good Luck to you , you will be fine

Thanks Jaime, I appreciate you thorough response.

Was your dressing only at the drain exit site and on the belly button? Or was it also all along the stapled incision?

When will you be able to stand up straighter and is this painful? Do you sit or lay down most of the day, any special position that works better? I am not sure if you have to keep your legs elevated for a good part of the day.

I purchased a fixture that I can slide under my mattress and will act like a railing on the side of the bed, It will give me something to hold on to or to pull from when getting out of bed.


I will keep you posted and will try to post when I get home.

Take care