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Monday, April 13, 2009

4/13/09 Go To The Back Of The Class

I’m home from our long weekend. I took DD back to college this morning and I’ve got an hour here before I start running the boys places. I typed this up on our way to Ohio, but couldn’t use my computer there, so here’s my blog from the pre-op class last Thursday.


Class was interesting, to say the least (read the end paragraph for the interesting part). It was evenly split with LB and RNY patients. We (bandsters) picked up literature depending on which type of band we had chosen (LB or Realize, I’ve chosen LB). I’ll only list the key things I learned that are different between my procedures and what I’ve seen from most others.

--Diet: There is no specific pre-op diet although they do ask you to cut back on fat and sugar for one-two weeks prior. Others here were interested so I did ask why there is no ‘shrink the liver diet’ and if it only pertained to those of us with a low BMI. Apparently no one (regardless of BMI) is required to do a specific pre-op diet and they have never cancelled anyone’s surgery (or closed them up) because their liver was too large. They’ve had no problems with large livers, but she did mention that if you do eliminate most of the fat and sugar for liver shrinkage before that it can help with reducing the post pain/trauma to your body later...smaller liver is easier to move. She couldn’t believe that some docs refuse to do surgery if your liver is too large (I asked this). They are getting ready to implement offering Bariatric Advantage products including the shakes and vitamins, but this is geared more for right after surgery and will still probably be optional before.

--Day Before: There is no enema. Only procedures are using antibacterial body soap for two days prior in the shower and the clear liquid diet/nothing after midnight that everyone else seems to do

Surgery/Hospital Stay

--Catheter: There is no catheter for the LB procedure (it seems like many others do have this).

--Fill: My doc does not put any fill in the LB at surgery (I was bummed about this, but apparently they do this because some never need any more restriction than the LB itself being placed; no fills ever).

--Incisions: Mine will be closed with glue and steri strips (no stitches or staples like some have). The strips can come off at one week at home.

--Gas X: It’s fine to bring this and use it at the hospital, but again they say that it does no good for the air that’s pumped into your abdomen, it will only help the gas in your digestive tract (I’m bringing it anyway even if it’s a placebo, it can’t hurt).

--Overnight: My docs require a one night stay for the LB procedure and insurance covers this. The only bad part about this is that you don’t get to do the barium swallow/x-ray test until the next morning…so only the ‘wet swabs’ (blech) in your mouth until the next morning. I will get a Doppler test on my legs the next day to check for blood clots. I’m not sure if I’ve heard anyone mention having this done.

--Meds.: They’ll send me home with Rx for a pain med (liquid Roxacet (sp?)/like Percocet) and Nexium for the stomach, no anti-nausea meds. unless you have a problem in the hospital (I’m going to insist on getting something I know my stomach, if anyone will puke it will be me).

--Schedule/Fills: Mine’s a little different than some. I see the doc post-op at 2-3 weeks and then the first fill isn’t until 6 weeks. Then every 4-6 weeks as needed for fills.

--Diet: Liquids only for 2-3 weeks/until post-op visit (this sounds like the longest I’ve heard, but I guess I’m paying for the no pre-op diet LOL). I’ve stated this before, but I will again since it’s different than most docs plans; my diet past the first two weeks is never to include protein drinks (protein should come from solids and that’s the purpose of the band to keep you full with food, not sliders. She did mention adding whey/protein powders to your food if you need extra protein.). The 2nd phase got a little confusing as she said that we are not to make/use pureed foods. The doc would rather we chewed soft foods to an almost liquid stage ourselves. I had to ask several questions to get to the bottom of this, but apparently they feel pureed stuff will slip through too fast and leave you hungry…hmm (I get this in the final stage, but mushies?). Pulverize with your mouth or a blender, I don’t see the difference. I told her I’d already made some pureed/froze them and she said to go ahead and use them (hey it’s 2 weeks, no biggie). After that, the diet is the same as others except you can drink black coffee as long as you compensate by drinking extra water, and you can drink diet pop as long as it has gone flat.

--Exercise: No lifting, pulling, pushing or treadmill (hadn’t seen anyone mention no treadmill before) until you’ve seen the doc post-op.

Other than that, everything was pretty much the same as everyone else. Now here’s the interesting part. She finished with the presentation and took a few questions and then said “I’m sure that you’ve all heard that Dr. XXX has left the practice.” WHAT? HUH? There was a unanimous “NO!” She meekly comes back with “Yes, we were all surprised too, apparently he just turned in a letter on Monday and has gone to (competitor).” (She was obviously not happy and somewhat stressed by this).Dr. XXX was the senior partner of the 2 man practice and is very well known in the area. They scheduled surgeries side by side and did them together for more difficult cases. Like I’ve mentioned before, my docs get a lot of the cases that the other hospitals (competitor hospital sent them patients all the time) in the area won’t take (i.e. Hard revisions, super M. Obese, etc.). Pittsburgh is well known as a strong medical city and I had 3 Bariatric Centers of Excellence within a few miles of each other to choose from (and there are several others in the surrounding area). (competitor) is the big conglomerate in the area though that has been buying up the smaller hospitals…apparently they offered him a bundle. Well, all hell broke loose at that point (quietly, but it was so tense you could feel it), it was a mixed period of stunned silence and occasional questions blurted out. I’m perfectly comfortable with my doc (the 2nd doc, and I met him at the seminar), he’s been doing laparoscopic procedures for many years and has done hundreds of bandings, and he’s well know as pioneering some of the cutting edge laparoscopic procedures (like the DaVinci robot that is run from a different room…actually more precise laparoscopically than by hand, so they use this in difficult cases). But I’ll have to tell you, that even I was thinking through…What if he needs help? There’s no one there! Then I’m thinking, what if they postpone my surgery…how can one guy handle the surgical load of 2? The worst part was that we didn’t know this before the class…poorly handled. Some people were asking tons of questions (had never even met the other Dr. and especially with an RNY, I’d be worried too!). She offered to set up meetings with the other doc for people who hadn’t met him. Here’s hoping my surgery doesn’t get postponed! The class left on a pretty uncomfortable note…not the way you want to feel a few weeks before surgery when you’re already nervous.

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