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[IP] Pumping and Surgery

Herešs a report on my experience on 7/13/00. I had a bilateral laparoscopic
hernia repair (with mesh). The surgery was successful, and the pump
experience was all positive. The only unfavorable thing to report is that
after the surgery I could not urinate, so they had to install a Foley
catheter which will remain until 7/18.

In a previous message I expressed concern about not having local family or
friends who could be at the hospital with me. Subsequently I arranged with
my sister from Los Angeles to be there. I didnšt attempt to teach her how to
do a BG test, and I didnšt attempt to get her into the recovery room.

No one gave me any trouble about wearing the pump thru surgery. There was a
potential problem with the anesthesiologist, who introduced himself to me on
7/13 in the pre-surgery area as a replacement for another anesthesiologist
(apparently lined up by the surgeon) from the same office. He was receptive
to my using the pump, but he asked me a couple of questions about how he
thought the pump would automatically administer a meal bolus.  I explained
to him how the pump really works and he accepted that.

Last food before surgery was at 5:30AM at which time the BG was 138. I had
intended to have a pre-surgery BG of 150-200, but around 9:30AM I saw a BG
of 137 and subsequent hourly BGs were on a downward trend of 120, 95, 89. So
starting at 9:30 I resorted to the only remaining tool to elevate my BG. I
substituted a temp basal rate that was lower than the normal basal of 0.4.
>From 10AM to noon the temp rate was 0.3. Before noon I was still on the
downward trend so from noon to 3PM I set the temp rate to 0.1. By 2:30PM the
BG was up to 140 on a rising trend, so I let the normal basal of 0.4 go into
effect at 3PM, and that automatically changed to the normal rate of 0.6 from
4PM to 7:30PM.

In the pre-surgery area they started a saline IV (Lactated Ringers Solution)
. I checked to be sure it wasnšt dextrose. Fortunately no one wanted to use
dextrose. About 4PM the anesthesiologist injected a couple of things in the
IV that knocked me out just as I was arriving in the OR.

Sometime between 6 and 7PM I realized that I was in the recovery room but I
donšt have a coherent picture of what happened there. I think they tested my
BG and I think they told me what it was, but beyond concluding that it was
OK I have no record of what it was. About 7PM they took me to my room. I
hadnšt been to that room before the surgery. It was a semi-private, as
dictated by Medicare, and the other bed was empty. About midnight they
informed me that an appendectomy would be coming in to the other bed, and he
arrived from surgery about 1AM. About 9PM they brought tea, boullion, orange
juice and gelatin. I tested BG at 102 and bolused 1.4 to cover my estimate
of the carbs. By 10PM they had me standing beside the bed trying to use the
urinal. It was about 5 feet from a huge unshaded window (6th floor, no
nearby buildings), but I donšt think it was the window that made it
impossible for me to urinate! I had straight catheters at 10PM and 1AM that
emptied my bladder and were then removed. At 4AM the male nurse who was
doing the catheterizing decided to use a Foley catheter and to leave it in.
About 5:30AM a resident from my surgeonšs staff came in and examined me.
About 8:45AM my surgeon came in and we worked out plans for going home with
the Foley catheter and for removing it on Tuesday 7/18).

At 7AM my BG was 67 so I ate 2 glucose tablets. Breakfast didnšt come until
after 8AM and I was disappointed to find that it was liquid (apple juice,
vegetable broth, coffee, and gelatin). At 10AM my BG test showed 57 so I ate
4 glucose tablets and then rang for the nurse. She came promptly. I told her
that BG was 57 and that I needed fruit juice. In less than one minute she
was back with 4 oz of apple juice. I was really impressed with her quick

By 11:45AM my sister and I were on our way to my home.

While I was at the hospital I had no contact with my endo, and none was
needed. They had his phone number. He and my surgeon had discussed the case,
and particularly the pump, about a week prior to the surgery.

The only reservations I have are in the way anesthesiologists are arranged
less than 24 hours before surgery, and they remain anonymous until first
meeting the patient in the pre-surgery area even though the patient may have
important concerns. At least thatšs how it seems to be in this community.
Anesthesiologists are MDs but they are responsible for keeping the patient
alive throughout the surgery.
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