My advice for pre-op patients:
I am both a nurse and a bariatric surgery patient. I have been an RN for almost 40 years, and had my Lap RNY in September, 2005 (and I’m doing GREAT!). Here is my advice:
1. Maintain a POSITIVE attitude. Do not underestimate the power of the mind. Using a technique called ‘Positive Intentionality” you can influence the outcome of your surgery. Starting weeks before your surgery, think about what you want to happen post-op. Make a list, and then tell yourself that they WILL happen. For example, you might say: “My surgery WILL have a good outcome. I WILL do well post-op. There WILL be NO complications. I WILL resist infection. I will have VERY LITTLE post-op pain. I WILL feel good after surgery. I WILL be able to get up and walk as soon as they want me to.” Each night, before you go to sleep, recite your list several times. When you wake up, recite it again. BELIEVE in your list, and it will happen. You can also try it before your surgery. Pick something that you want to happen and visualize it happening. Tell yourself it WILL happen according to your list. For more information you can Google the term “positive intentionality.”
2. Be an advocate for yourself: Remember, this surgery is FOR YOU so that YOU can have a better life. Don’t let others make decisions for you that you don’t like. If you have to wait a long time for an appointment with your doctor/dietitian, etc. then call several times before your appointment to see if they have a cancellation. If your insurance rejects your request for surgery, fight back. Write up an appeal letter. There’s information on this web site on how to appeal. Get someone else to help you write the letter if you need to – just DO IT!
3. Improve your overall nutrition BEFORE surgery. Get yourself as healthy as you can pre-op. If you’re not taking a good multi-vitamin every day - start. If you’re not exercising as much as you can, then begin. Are you getting enough calcium? Protein is important for wound healing – are you getting enough? Are you taking ALL of your medications the way you are supposed to? Exercise - even a little exercise is better than none. Start walking. If you can’t walk, use your arms – try lifting books, cans of vegetables, or anything handy. This will improve your circulation and force you to breathe more deeply – which is important. It will also give you a greater sense of control over yourself – which when paired with #1 can be powerful!
4. Practice getting out of bed properly. You’ve been getting in and out of bed all of your life, but how you do it post-op will make a difference in your pain. The best way is to roll totally onto your side. Roll as close to the edge of the bed as you can. Then, stick your legs out over the edge of the bed. Next, using BOTH of your arms, PUSH yourself up off the mattress while lowering your feet to the floor. It’s important that you PUSH yourself up. If you pull, you will be using your abdominal muscles – and they’re the ones that will be sore! This is especially important for those who have open procedures rather than laparoscopic.
It’s OK to use the siderail, or a chair placed next to your bed to help. Just make sure you’re pushing, not pulling. Practice this at home and be good at it before your surgery.
5. Talk to your surgeon AND anesthesiologist about PREEMPTIVE ANALGESIA. The theory behind preemptive analgesia is that the presence of analgesia (pain reducing medications) immediately prior to the surgery prevents the sensitization of the pain nerves. With preemptive analgesia there can be a reduction in the NEED for postoperative pain medications. http://www.lighterforlife.com/PDF/SOARD_1(2005)_12-16.pdf
6. Cough, deep breathe and walk, walk, walk. The sedation and anesthesia will make you breathe more shallowly. By not fully inflating your lungs, you increase the possibility of developing a post-op pneumonia (a totally avoidable complication). If you are given a device to help you deep breathe – use it. If not, remind yourself to do it frequently. You will also need to cough. Not just a little throat clearing, but good SOLID coughs! If you have an open procedure this may hurt more to do. Use a pillow, a folded up soft blanket, a teddy bear, or anything that works to brace your abdomen before you cough. Put the pillow over your operative area, pull your elbows in, next to your body, and hug the pillow. While you’re hugging, take a deep breath and cough. If it’s too uncomfortable, then make sure you do it SEVERAL TIMES shortly after you get your pain med. You also need to move your feet and legs while you’re in bed. Prolonged bedrest can promote blood clots in the legs. Bend your knees up, then straighten them out. Do one leg, then the other. Do this several times. Repeat several times a day. Move your feet up and down, as if you were stepping on the gas pedal. Get those leg muscles moving and keep that blood circulating! Most importantly – GET OUT OF BED! As soon as you can, start getting up. Take a walk up and down the corridor. This is good for your breathing, for your circulation, and for your sense of control over your situation. Walk several times a day. If you’re severely obese and have limited mobility, at least get up to a chair. While in the chair your lungs will function more properly, and you will find it easier to cough and deep breathe.
7. Remember that the effects of anesthesia can last for several days. If you’re discharged in 48 hours (as I was) you may find yourself needing naps. Take naps, just DO NOT STAY IN BED! Try to wean yourself off of your pain medication as soon as possible. If you are given a narcotic, ask yourself if you truly need it. If not, try Tylenol instead (you can always take the narcotic later).
8. Organize yourself at home. List the medications you will need to take every day.
Make a chart so that you can write down how much protein you take in, and how much fluid you drink. After the first week you may not need this any more, but to get started it can be helpful.
9. Before surgery, make sure you have the following items on hand:
• Thermometer
• Pill crusher
• Protein drinks
• Shaker jar for protein drinks made from powder
• Flavored drinks and refillable bottle (crystal light, etc.)
• Pen & paper to write down all of the questions for your surgeon & nutritionist.
• Phone number of your surgeon and primary physician.
10. Know when to call your doctor. You should take your temperature at least twice a day. As long as it’s below 100.1 (or whatever your doctor says) it’s OK. If it goes higher, call your physician. Write your temperature on your protein chart. Inspect your incision or lap sites daily. Make note of any discharge, drainage or odor. Check for redness of the site. If redness or drainage increases, or if an odor develops – call your doctor. If you had a urinary catheter while in the hospital, it’s possible to get a urinary infection. If you experience burning, urgency, frequency or “hot urine,” you should let your doctor know right away. If you have any of these, pee into a clean jar and look at your urine. It should be clear. If it’s at all cloudy there’s a chance you have an infection. If you have a productive cough, look at what you cough up. It should be clear to white. If you see greenish or brownish colors, call your doctor. If you’re inactive after your surgery and develop blood clots in your legs, you will feel some new pain in your leg (usually one leg, but could be both). That leg will become slightly swollen. Call your doctor.
11. Remind yourself of why you had the surgery. Losing weight is only part of the reason. Getting healthy, staying healthy and taking control of your life are the main reasons. Being obese and unhealthy wasn’t easy. It won’t be easy getting better – at least not for awhile. However, it will get easier, and you will feel better. You deserve it!
Good Luck!
Teana