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[IP] surgery tips

Tonya wrote:
>  You have been recommended 1,000 times over...I am getting ready to
>  have surgery for XXXXX(ailment of tummy area).  I am worried about 
>  the pump and all. 

Hey Tonya

I am gonna respond to you privately and send it to the list too, cuz it is a
good question, and I know Janine is also in the same boat.  It is kinda long
and I have pulled things from other posts I made at the time of my surgery.
Maybe some organized person could turn this into a FAQ?

In February, After 3 weeks of fiddling with inept doctors and an unorganized
hospital (NYU), I underwent a laparotomy (at Northwestern in Chicago) to find
out why I was having such horrible cramps and no bowel activity...It turned
out to be a burst appendix which was removed - nice business trip!

First off, find out if they are gonna do a laproscopy or a laparotomy.  If it
is the "scopy" I think they go thru your belly button and there is very little
scarring.  If it is the laparotomy, they slice and dice you stem to stern, and
if the surgeoun is a sloppy sewer it leaves a nasty scar.  Both you and Janine
said laproscopy, so I don't think you have anything to worry about scar-wise.
In Janine's case I think she said they might do a C-section type cut, which is
lower and horizontal - it is also a lot lower than I would ever want to put my

For the actual surgery, I wore the pump in my leg - I use tender/silhouettes,
but it might be easier with a bent needle if you have less flab on your leg.
I wouldn't want the pump anywhere near where some doctor might get his hands
on it and mess it up.  GET PRIOR APPROVAL, get it in writing and keep a copy
of it with you and demand it, if you decide you want to keep your pump.  

Since you have advance warning, why not practice there for the next few times
- I have noticed a difference in absorbtion when I use my leg than in my
flabby belly.  The only tough part about having it there is when you pull your
pants down for the variety of things we pull our pants down for...(shut up
Forrest, and you too Greg)

In Chicago, the head nurse came to me the night before and said the nurse team
didn't "feel" comfortable with me keeping my pump on during the surgery.  I
told her "I understand how you feel."  PERIOD.  She stood there, waiting, like
I was gonna just unplug it and let her jab me with a 10mm syringe.  We had a
staring contest for a few seconds, and she repeated her "concern, for herself
and the department."  I referred her to the endo who had been assigned to me.
He had already said it was OK (which was lucky for him, cuz then he would have
to head butt with me too.).  Then I just turned my hospital-gown-clad back to
her - I don't remember if I had drawers on or not...you get the idea

Ask to speak to the anesthesia person.  Tell him you are on the pump, and you
want to keep them at XXX.  If you have had surgery before, tell him, and what
your reaction to the anesthesia was - I had a severe reaction to the
anesthesia after my vittrectomy and almost puked my newly stitched eyeball out
of my head...so I guess they used something different for my laparotomy.  

TESTING BLOOD:  Find out how long you will be out after the surgery, meaning
can you do your tests?  Ask your diabetes doctor for the range he thinks is
best and then make sure he tells your OTHER doctor what the instructions are.
They have to talk to each other!! otherwise you will be treated like just
another "diabetic" patient.  I suggest testing every hour or 2 starting the
night before, making sure you are where you want to be - aim for higher than
you normally do - I aimed for 150-200, rather than 100-150 - it is better to
be a little higher than a little lower. Don't forget, you will probably be
fasting, but the stress of the surgery may cause a rise in surgery - consider
this when you look at basal rates.  

Make sure everyone knows you want your meter in recovery with you.  I brought
it into the surgery with me - it clasped in one tight hand and the pump in the
other.   If you are gonna be out of it for awhile, is there someone you trust
to do your blood tests and cover for highs?  You might train someone - hubby/
friend or whoever, write it out for him. ie "If I am 150-180 - fine, if I am
administrer X insulin, if i am 220-250, administer X."   Remember, nurses
change shifts every 8 hours and you may have a cool one before you go into
surgery who understands everything, and then when you come out, the shift has
changed, and you are stuck with Nurse Ratchet who don't take no know-it-all
sh*t from patients!

Bring your own meter and strips and any other prescription meds you take - ask
your doctor if you should continue taking any of those other meds.  You would
be shocked to know what they charge if they provide them - and THEN when you
get the bill...make sure they dont sneak those charges in - like strips,
insulin etc.  BRING YOUR OWN, unless you WANT to pay $5.00 or more per poke,
or $25 for a bottle of insulin - if they DO charge  you - make sure and let
your insurance company know they over charged you.  After my vitrectomy (94)
my insurance was so happy to find out that they had been overcharged, that
they paid me the difference in what they got back.

IV FLUIDS:  Unless you aren't going to be able to eat for more than 1/2 a day,
I suggest you ask/demand (ask your doc) for the saline IV - if you WON'T be
eating for a while, go ahead and take the sugar water/dextrose IV.  It will
give your brain the necessary CHO to keep you from going into starvation
ketosis without driving your sugars over the cliff - YOU NEED ABOUT 150 gms
CHO per day to avoid starvation ketosis.  I think a 2.5% 1 litre bag has 85
calories (21 CHO), a 5% 1 litre bag has 170 calories (42 CHO)  You have to
figure out how much you are getting - Look at the flow rate on the  IV machine
- if it says 100 - that means you are getting 100ml per hour, so a 1 litre bag
of IV is gonna last ya 10 hours...If you are on D5%, you will get that 170
calories spread out over 10 hours.  If you are at 250  rate, you will get the
whole 170 calories in 4 hours...and so forth.  THIS IS IMPORTANT TO KNOW SO

CT SCAN:  If you need a CT scan, ask your endo if you should be worried about
your kidney function.  If you have impaired function, like me, you DO NOT want
the IV contrast - this is a dye they inject you with that helps them see
whatever it is they are looking at in a CT scan - this is BAD for your

Bring a supply of glucose tabs.  You would be surprised to learn that many
hospitals don't have them.  You may need them if you are on saline IV, or if
you aren't PERFECT with your basals, and who among us is??? 

AFTER THE SURGERY - if you are in pain and they give you drugs - remember that
will probably make your sugars rise - Demerol and valium do it to me, but what
a nice floaty feeling...who CAREs if you are little high ahhhhh
>  I am afraid all
>  the messing with my stomach area will effect absorption?!   

The scar I have is literally right down my middle and I never used that area
in the first place for sites - I tend to stay about an inch and a half on
either side of my belly button, so the scar and the resulting scar tissue
underneath is not a problem.  I also had a drain hole, for whatever that vile
fluid was that leaked out after the surgery - there is a "site=sized" scar
there, in a place that I would use, but as Buddy, and now Janine, can tell
you, I have room to spare in terms of site rotation.

SO!!  anything else, please feel free to ask here or in private


*-)=B xoxx
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