dragging fatigue?

One week out today.  No real incision pain... if I stretch my arms, then the upper back stings so I try to not do that, but that's really it.

But I am beat!  I sleep for 4 hours, take pain meds, sleep for 4 hours, take meds, eat, sleep for 2 hours, eat, talk to DH for an hour or so, sleep some more... will I ever wake up??

I agree with the surgeon, given the low level of pain, I can return to work on 1-03-11.  But if I don't start staying awake for more than an hour at a time, work is NOT going to work!  Please tell me that I'm obsessing unnecessarily - it would calm me down a whole bunch!

I've discovered that I've become a turtle.  I have no problem "assuming the lawn chair position" in bed or the recliner, but once I'm on my back, I can't get up unless someone takes my hands and pulls me straight up.  No pain with that, which is weird, but DH says all he has to do to keep track of me now is leave me on my back.  I'll either fall back asleep, or lay there plotting and pushing cats off my stomach (they want to love me... too much).

I think its still early yet and the fatigue is normal.  I had my TT on 12/17 and I find that I sleep alot also or just don't have much energy to do anything.  I went out today to the store and post office and was exhusted from that short two trips...I am told I can go back to work mid Jan. so I hope the fatigue gets better too.  Hang in there and just rest as much as possible. 

Val

 

Aloha PM 21-

This is not necessarily directed at you but at anyone cruising the Plastics board who is considering PS--

First off,  plastics involves a heck of alot more anesthetic time, surgery time, healing, etc than most WLS procedures- it is ALOT more trauma than an RNY or a VSG ( eg typical VSG takes 45 mins, CBL/BL/BA takes 7 hours and has alot more tissue trauma). So your recovery time, even if pain free, is longer- figure a typical RNY lasts 2 hours, even with 2 surgeons working on you, your anesthetic time was probably at least double that. And instead of 5 tiny laparoscoipic incisions, you have majorly impressive muscle and skin incisions that need to heal. Ypu had even more work with your arms as well- I skipped my arms, just the circumferential and breast work.

Second- in a way,  you are still recovering from your first surgery ( RNY) if your posted dates are correct- you had your RNY just one year ago, in 12/2009? And plastics in 12/2010? FWIW, most plastic surgeons ( at least the 3 I consulted with, and the 4th I heard lecture) recommend no plastics until the WLS patient has been at goal and maintaining for 9 months or more. Your body is still adjusting to reduced calories, altered sleep positions, metabolizing drugs (like anesthetics and narcotics) as well as hormonal changes as your fat burns off and releases impressive amounts of fat-soluble hormones like estrogen, progesterone, and cortisol, etc. I was fatigued from my VSG for 3 months, and about the same from plastics. And I had been maintaining  at 132-135 for 10 months before I tackled plastics.

Third - most PSs recommend their patients be in the best physical shape possible and have lots of protein stores ( = MUSCLE) to draw on when you don't feel like eating post op. I was going to the gym 5-7 days per week, doing a combination of cardio and weight training, and had my body fat down to 17% when I did my CBL/BL/BA-  but the surgeon I chose said he wouldn't do those procedures all at once on every patient, only those who he felt could handle the physically demanding recovery. And boy, I thanked my trainers for the hundreds of weekly squats and Core work they had me doing---- it definitely made recovery easier and faster---- standing upright the same night as surgery, cleared for stretching and yoga 12 days post op, cleared for cardio and light weights 21 days post op ( I had been warned it would be a week before I stood upright, and likely 6 weeks before I could return to my former workout routine).  But those first easy  stretching/yoga workouts at 12 days were EXHAUSTING---- I was pooped after 20 mins whereas pre op I was doing 90 minutes at a stint. My PS also believes that you have a faster and easier recovery if you are at maximum fitness, flexibility, muscle mass, etc and really pushes the Core work. I soon discovered that you use your core for everything- turning over in bed, gettting up off the toilet, reaching across the table for your sipper mug, getting in and out of a car, picking stuff up off the floor- EVERYTHING!

So even if you are in excellent physical shape, and have maintained your weight for 6-9 months, and have plemty of muscle stores, you are still likely to be fatigued (but shouldn't be painful) because there is a tremendous amount of healing that takes place. Add onto that age ( eg I'm 50),  kids ( eg I have 2   2-legged and 3   4-legged) and work schedule ( eg I work double shift grave yards -  two to  three 16-hour shifts per week) , and it's easy to see why you might be exhausted. Sleeping in a "W" position on your back  ( I used tempurpedic pillows)  challenges your sleep patterns even further. You should be able to get up on your own, though- are you sleeping inclined like in a recliner ( I had a very large triangle pillow behind me keeping me inclined and bent at the waist, a second smaller triangle pillow under my knees to keep them bent,  and a third small wavy pillow used either  for my neck or arms- hence the "W" position)? Maybe you are too prone and need to elevate your upper body. Do you have any trouble getting up off the toilet or up off a chair? 

One last thing ( I harp on this all the time)-  are you getting in sufficient calories, protein, and liquids? You gotta have protein to heal all those skin and muscle incisions and to have your own body function normally as far as enzymes and immune system - if you aren't getting enough protein in, your incisions will use your muscle as their source of protein, which can lead to more fatigue as your body becomes weaker. You gotta get in sufficient calories even though you might have little or no appetite, because otherwise you'll burn body protein just to cover your resting metabolic needs, and will become weaker as you lose muscle. And you gotta get sufficient liquids in to help your kidneys and liver flush out the anesthetic metabolites/drug residues. Don't forget your vitamins! As an RNY patient, you have an absolute requirement for your fat soluble vitamins because you malabsorb some of your fat...I'm not sure what the implications are as far as your Vit B needs ( VSGers might lack intrinsic factor, which is used to absorb Vit B in particular B12) ----but don't neglect your Multi Vite and your B complex and B12-  B vites are my new caffeine!

Sorry this is so long - I have seen 4 of my WLS friends from group go through plastics ( 3 used the same surgeon as I did) and those that followed his trules healed rapidly and with beautifully thin scars - the fatigue might last a while, though, hopefully I;ve outlined why! Take those naps when you can! Be well, healthy healing to you- XOXOLori

Very good reply and very informative.  Thank you for this post.

Lori - THANK YOU!!!

Those were a lot of factors i hadn't considered, which was why I posted here.

A bit more info -  Yes, my rny and PS were a year apart.  I had maintained at goal (and gone a bit below by 6 months out from the rny.  Body fat, at time of PS, was 19.6 and was as low as my PS and other physicians wanted me to be at 55.  Core and muscle strength has been great - if I'm too prone, I need a pull up to a W.  Otherwise, no problems doing anything.  Yes, standing upright and walking around the evening after surgery (when I wasn't falling asleep in mid-word).

My intent had been to wait another 6 months to a year before PS, but I wound up with a chronically pulled/torn chest wall muscle that, per the breast specialist at my ob/gyny would only heal correctly if I had BR/BL/brachio, so that pushed the time table up. (The PS said it was very unusual having an ob/gyny refer for PS, but that's where it came from!).  The CBL maybe could have waited, but once the upper was scheduled, the cleansing 3x daily and scarring just led me to say WTH, and have it done too.

You're also correct - my rny/gall bladder was done in just over 2 hours, while the ps took just over 5 with the tag team.  and yes, I had not considered the wierd absorptive factors for the anesthesia, just assumed that once I'd spent a few days out, it was gone.  I am off all pain meds at this time with the occasional exception of extra strength tylenol - not being stoic, it just doesn't hurt.  Pre-op I was getting 150-180 g protein per day for 2 months, and 100-125 g per day before that.  Because of the sleeping, I'm probably down to 100-125 g protein per day, but am working on getting that back up.  Calories... maintaining at 1500-1800 per day (any less and I continue to drop weight), and vits... other than the day of surgery and the day after, I have maintained all vitamins. 

I do sleep at least half the night in a recliner with a triangle pillow under my knees, and have no problem getting in and out.  But I miss my actual bed, so I have a wedge reading pillow and another triangle pillow there for the other half of the night.  I can get in and out as long as I stay on the pillows, but if I shove them away in the night to lay flat, I "turtle" and need DH to pull me up.  No problems with toilets or chairs, or getting in or out of either my Mustang GT (not driving yet) or DH's oversized manly man pick up truck.

Thank you again for your info - I was so focused on WHY this surgery wasn't healing (as in letting me do things like stay awake) the way previous surgeries had, that I had totally missed the point that my body was no longer the same and couldn't react the same way.  I really appreciate your info - it was exactly what I needed to hear.

Aloha Rebecca-
 
You sound as if you are doing exactly what you should be, good for you!!!  And you were SMART SMART SMART to research this ahead of time and know what you were getting into- so many people think this is a walk in the park, and are not aware of how much tissue trauma and anesthetic/surgery time there is. Be prepared, people, and you'll have a far easier recovery....I keep telling this to my clients at work ( I'm a vet), and friends/relatives who are having any type of surgery- you get one chance and one chance only at healing right the first time. So take the extra time off work, there are no short cuts other than being very prepared ahead of time. LOVE the increased protein for rapid healing. And it's TOUGH to get those calories in post op- I have to hit 2600/day or I ldrop weight, and it's tough with no room in your stomach and no appetite ( but I consider those to be GOOD problems, HA!)

Continued good healing to you, and thanks for being such a good poster!!! XOXOLori

Rebecca,
Don't forget too, that your pain meds will make you sleepy too.

Tonya

Thanks, Tonya!  Those are gone... so now it's just the residual anesthesia and general healing.

I am three weeks out and the fatique comes and goes . . . And, the pain changes intensity and location so be prepared for that . . .