Pre & Post Operation Treatment and Wound Care

[GNC Crohn's Man]

I'm gonna divide this into three sections. 1st section is for pre-op care. 2nd section will cover the time you are in the hospital. 3rd section will cover home care.

PRE-OP QUESTIONS AND PREPARATIONS

Before you agree to let someone cut you open, it is a good idea to meet them first. Always ask your GI doctor what surgeon he/she would want if someone had to perform this surgery on him/her. Also, make sure that you know what Hospital you will be going to. You need a hospital with a good and not horribly overburdened nursing staff. The nurses are the ones who will be taking care of you after you have your surgery.

When you go to meet your surgeon to talk about the surgery, BRING A PEN AND SOME PAPER. There will be several questions you will need to ask him. I'm gonna steal the first set of questions from this pdf file.
http://www.ahrq.gov/consumer/surgery/surgery.pdf
The second set are the questions they leave out that I ask my surgeons.

If your doctor does not want to answer your questions you should fire him on the spot. This is a person who will be cutting you open and taking out your insides. You don't want someone who is incompetent or uncooperative to operate on you. If your doctor can not answer all of your questions at that time then give him the list of questions and have a nurse call you with the answers.

Some these questions may seem dumb. Ask them anyway. I know I would rather be alive and seem dumb; than be dead and seem smart. The extra stuff in (parenthesis) is the added info by me.

1) Why do I need an operation?

2) What operation are you recommending?

3) Are there alternatives to surgery?

4) How much will the operation cost?

5) What are the benefits of having the operation?

6) What are the risks of having the operation?

7) What if I don't have this operation? (What will happen to me?)

8) Where can I get a second opinion? (Don't ask your surgeon this question ask your GI doctor; that is assuming you trust your GI doctor. The reason for not asking this question to the surgeon is if you don't trust this surgeons opinion of cutting you open, why would you be willing to trust there opinion on finding someone else to cut you open? )

9) What kind of anesthesia will I need? (He won't be able to answer this specifically. He can tell you if you will be under light, moderate, or heavy sedation and that's about it. Your surgeon is not the anesthesiologist. Only the anesthesiologist will know and even he will be vague. He will say I'm gonna start you off on X and go from there.)

10) How long will it take me to recover? (This should be a 3 part question. How long will it take me to partially heal so I can walk and move around more or less normally? How long will it take me to fully recover? How long will it take for me to recover enough to drive, and go to work/school.)

11) What are your qualifications?

12) How much experience do you have doing this operation? (This can be a misleading question not for the surgeon, but for you. Simply because the surgeon has done this operation a million times does not mean that he/she will do a fantastic job. My second surgeon did an ok job. He had done that operation a million times before. But, I'm pretty sure he cut me open and took everything out about as quick as he could to get on with the next patient. You want a Doctor who will focus completely on doing a excellent job not a quick job.)

13)At which hospital will the surgery be done?

14) How long will you be in the hospital?

15) Have the surgeon mark the site he/she will operate on. The surgeon will do this by writing directly on the patients skin on the day of the surgery.


Now it's time for my pre-op questions. If some of these questions sound condescending or mean it is because they are. I would rather be alive and rude, than dead and polite.

What am I going to need for wound care treatment at home?

After my surgery will I require any special equipment such as crutches or a wheelchair?

How much of a risk for infection will I have post-op?

What are the dos and don'ts of incision care?

How easily can the incision site become infected?

What are some simple ways to infect the incision site?

Can a stethoscope transfer a staph infection to the incision site?

Do you sanitize your stethoscope before and after use? Everytime?

Did you know that Doctors (not nurses) are the leading cause of staph infections and deaths by infections post-op?

Do you mind if myself or someone else watches you like a hawk to make sure you don't infect me post-op?

Is there anything you or the nurses can do to reduce the risk of infection post up? Special dressings? Etc?

When will the incision site heal enough to negate the risk of a secondary post-op infection?

What items should not be brought into the hospital while the incision is healing and I'm still at a risk of infection? (Ask this question even though I just gave you a good answer. You shouldn't bring anything from home that may directly or indirectly touch the incision site or even your gown. That means no hugs. No clothes from home barring socks [and underwear if it is away from the incision site. If not then no underwear.] The other leading cause of infection in post-op care are unsterilized items brought from home or purchased as a gift at a store. Also hugs, NO HUGS!)

Can those prohibited items mentioned above touch my gown spreading bacteria to it and then from the gown to the incision site? (The answer is yes. Ask anyway to make sure you both know all the things that can cause an infection. Doctor's are normally smart and knowledgeable, but sometimes they forget that.)

That's it for the question round for the surgeon of pre-op care. If you have another question you think you should ask your surgeon then post it in this thread and I'll update this post.
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If you are going to have to be in the hospital post-op, then you should ALWAYS HAVE SOMEONE WITH YOU AT ALL TIMES!! You'll need to talk to your friends, family, loved ones, and/or whoever else you can think of; make sure AHEAD OF TIME that you have a person or people that can stay with you while you are in the hospital. Nurses/machines/doctors don't catch everything that can go wrong while you are healing. If you can, make sure you, or someone else, can bring all of the stuff you need from home. Tooth brush, toothpaste, socks, etc.


If you are gonna have to be in the hospital post-op then you may want to go ahead and talk to your surgeon about pain management. You should do this BEFORE THE SURGERY!! You need to know what kind of pain meds you will be on. Morphine drip, pills, etc... If you are gonna be on a morphine drip then I'm gonna go ahead and warn you. You more than likely will not be able to press the button for the morphine the night after the surgery. You will mainly be drifting in and out of consciousness. You will more than likely wake up at some point in SEVERE PAIN because you were unconscious and did not press the morphine drip button. It may take a while before you are out of severe pain land. If you think this may happen to you; you can talk to your doctor about a "Break through Pain Med" . That is a very strong pain med that they can give you if you wake up in severe pain and the morphine drip is way to slow in responding. It will take away the pain and probably knock you back into unconscious land too. BUT, you will need to TALK TO YOUR DOCTOR BEFORE YOUR SURGERYto get it. If this is your first surgery and you think you can just tough it out, "Good Luck to you will need it". If this is your second+ major surgery then you will understand what I just wrote.

That brings us to the next post...

 

[GNC Crohn's Man]

This post is the next part in this series. If your surgery does not require you to stay in the hospital afterward; you can skip to the next post.

POST-OP HOSPITAL CARE

If you didn't read the above post THEN YOU SHOULD READ IT!
If you post somewhere saying that "Ohh I saw this post but I didn't read it or think to remember anything for it and I had a horrible experience from my surgery...", then I'm gonna laugh at you. If you think I won't then try me.

Since you read the post above I don't need to repeat ANYTHING I have already written.

So, you should have your pain management taken care of, everything you need from home, someone with you at all times, and you should be much less likely to get a secondary infection.

Now I'm gonna give you a few warnings that hopefully shouldn't apply to you. If you choose to use a break through med then I would suggest that you use it sparingly. If you don't need it; don't use it. Your going to be very high on drugs, so you probably want to put whomever is with you in charge of giving the order for "the break through meds". Normally I would say to use your own judgment, but again if things are going right then you should be high as a kite and in no possible shape to make any kind of judgments regrading anything.

Apparently I went into a mini coma and turned blue and stopped breathing at some point while I was knocked out on the "morphine drip" + "break through meds" combo. I just remember waking up with a room full of people yelling and someone shaking me. I had no clue what was going on. I didn't find out until later what had happened. This also brings in the importance of HAVING SOMEONE WITH YOU AT ALL TIMES! Don't just trust a machine beeping to mean the different between life and death. Always have someone with you.

Other than that you should be fine. Also, once you go from the "morphine drip" to "pills"; you're gonna go from "Happy fun time land" back to the "real world". This will suck, but there's nothing you can do about it. If you need your pain meds then take them. They may cause some "extra damage", but for a while they will be getting rid of a lot more pain then they are creating.
After you start eating semi-solid food and begin to heal some, think about lowering the dosage as much as possible to avoid "extra damage". If you don't understand what I mean by "extra damage"; you should read this thread.
http://www.crohnsforum.com/showthread.php?t=1146

Before you are discharged from the hospital make sure they go over "wound treatment care" with both you and whoever will be with you once you get home. Also, make sure you have someone that can stay with you until you can do stuff by yourself.

That pretty much takes care of everything I have to say about Post-Op IN Hospital care.

 

[GNC Crohn's Man]

POST-OP AT HOME CARE

You and whoever will be staying with you should already have all of the necessary materials you will need for wound treatment and care. Make sure you get your pain med prescription filled as soon as you get out of the hospital. In the USA you cannot send someone else to pick up your narcotic pain meds. You must be there in person to receive them. That's why I say to get them first thing as soon as you get out of the hospital.

Make sure you follow your wound care instructions. You may or may not have to go back to your surgeon 1-2 weeks after the surgery to get staples/sutures removed. After a month or two you will need to see your surgeon again. This is pretty much a formality to make sure everything is fine.

Make sure you eat and also make sure you get up and walk around some. It will help with the healing process.

That's pretty much it. If you cover everything in pre-op then post-op you shouldn't have anything to worry about except healing as fast as possible.

 

[GNC Crohn's Man]

I'll leave this section open for later stuff if it is needed. Other than that this thread is done. If you have questions and/or comments then ask away.