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Re: [IP] Pumping and Surgery (LONG)

In a message dated 7/1/00 4:07:52 PM US Eastern Standard Time, 
email @ redacted writes:

<< I have been closely following this sequence of messages on pumping and 
 surgery for the past week because I am scheduled for laparoscopic hernia
 surgery on 7/13. I am at a loss to pick someone to be with me before and in
 recovery because I live alone and don't have any local relatives. I have a
 lot of questions to ask my endo. I understand that the endo has been in
 touch with the surgeon, but I don't know YET what the detailed plans are. >>

First of all, they probably won't do surgery unless you have somebody to take 
you home, so you'd best be looking. Second, the last time I was in the 
hospital, my husband checked my BGs after surgery -- not because I couldn't 
have myself, but because I just didn't feel like going through the trouble. 
That said ...

I have had two surgeries in the past year -- both on my foot and both with 
Elvis attached to me. The last surgery (for an infected bone) was less than a 
month ago, and also involved a 6-day hospital stay. For both surgeries, the 
anesthesiologists were the only ones who expressed concern.

For the first surgery, which was outpatient, the anesthesiologist told me she 
was concerned because I would have insulin going into my body the whole time 
I was in surgery. I told her that *she* would have insulin going into *her* 
body all during surgery, too. The little lightbulb came on over her head, 
then I explained to her how the pump worked (basals and boluses). No problems 
there (until I was in the recovery area and had to fight with a nurse to get 
a doughnut with my coffee -- and I'd brought the doughnuts so I could have 
one! grrrrrrrrrrrrr).

For my most recent surgery, I had to disabuse the anesthesiologist of the 
idea that the pump would automatically give me insulin to cover breakfast at 
a certain time. Again, a lesson in "Pumping 101." He did insist on giving me 
dextrose, but I was only 161 after surgery, so I just did a correction bolus. 
No big deal.

I don't know what kind of anesthesia you will be given but, in both my cases 
(and, actually, in the 4 foot surgeries I've had in the past two years -- 
non-DM-related, BTW), I've had this marvelous stuff they call "twilight 
sleep." One time they had music on in OR and I just listened to that the 
whole time; one time I was all the way out -- don't remember a thing; the 
last time I'd wake up once in awhile, look around, then drift back off. As 
for the other time ... well, suffice it to say that my podiatrist has been 
warned that if I get the same anesthesiologist, I will get up and walk out. 
In every case, they knocked me out until my foot was totally numb from a 
local, then brought me back out of the deep stuff.

The last time, I know that one of my podiatrist's first calls was to my endo, 
who basically told him, "I'm fine with that as long as she leaves her pump 

In any case, there's no reason for you to wait until somebody contacts you -- 
you can call and ask your endo and/or surgeon to call you as soon as 
possible. I have taken the attitude that I don't care if I'm "bothering" 
somebody -- if it's important to *me*, then I'm going to call and ask. I 
think most doctors understand and won't mind (as long as you don't make a 
frequent habit of it). I have been known to call my podiatrist at home and I 
called my endo from the hospital when I was having trouble keeping my BGs up. 
(I knew what to do, but just wanted confirmation.)

And for those of you who knew I was being hospitalized for a bone infection, 
but I have not gotten back to, I'm healing well and everything is as to be 
expected at this point. About 3/4 of an inch of bone was removed from my big 
toe, but my toe is still on my foot (which is still attached to my leg), so 
I'm grateful for that. They found two different types of bacteria, for which 
I'm taking two different types of IV antibiotic. I run one antibiotic in the 
morning and the other one in the evening. I even took the evening dose with 
me to my office one evening when I had to work late, thumb-tacked it to the 
bulletin board near my computer and ran a gravity drip while I worked. :-)

The sutures are out, the bandages are off, I got to toss that knee-high 
monstrosity of a walker on Thursday (YES!!!!), and all of the doctors and 
nurses who took care of me during my hospital stay are still alive (albeit 
only barely for a couple of them). Which had more to do with their idea of 
what constitutes "food" versus my idea of what constitutes "food" than 
anything else. Oh, yeah -- and the fact that they had "PATIENT HAS INSULIN 
PUMP!!!!!!" written on the outside of my chart, but failed to include my drug 
allergies, which almost caused a problem one time, but fortunately I 
remembered to ask if the drug they wanted to give me would cause a problem 
with my drug allergies. (OOPS!!!! I didn't get THAT one!!!)

All in all, I haven't had all that difficult a time with pumping during 
surgeries/hospital stay. I attribute that in large part to the fact that my 
doctors know that I am knowledgable about DM and about the pump and relay to 
the rest of the team that I can manage my own control to just do what I tell 
them to.

Jan (and Elvis)
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