Tuesday, July 17, 2012

Day 2

An uneventful night last night with one exception: I could not pee for about 18 hours after my surgery. This is expected, a function of the spinal narcotic getting in the way of normal bladder contractions, but it was weird. Of course, I haven't been drinking for all this time, but they have us on a hydrating IV for these first couple days until we are able to resume drinking. So you're still producing urine even without drinking.  I never reached the point of discomfort, but it's odd NEEDING to pee and being unable to do so.  And I was *almost* able to, it seemed, several times. I finally got up about 3:30 AM and sat there until something happened, damnit! And eventually a tiny, pathetic trickle came, barely measurable. I had been told that it got easier and easier as we went, and that has proven true.  I'm peeing like a champ now ;-)

This was my first time getting this spinal pain killer, and it's kind of miraculous! Just a tiny bit beneath the skin somewhere there along the spine and *poof!* no pain! None! Kind of amazing. (The anesthesiologist says a dose of morphine is normally measured in milligrams, but this spinal was just a few micrograms. Amazing.) Now it's worn off this morning--which is why I can pee, of course--and there are a few aches and pains but hardly worth mentioning.  Filling my lungs fully is a bit uncomfortable, and my drain on the left side hurts a little.  Actually, not the drain, but just the stomach in that area, like I had been doing too many (that is, ANY) sit-ups.

Tough to see in the picture, but there are four small holes covered in tape, and a bigger hole at the drain.  The icky-looking stuff in the drain is the leftover from surgery. There's a little bleeding during the surgery, and then the chest cavity is rinsed out; most of this is the leftover from the rinsing.

This morning we get our second test of the staple line to be sure it's not leaking (though very rare, this is this particular surgery's chief risk, a leaking staple line; these typically show themselves right away). The staple line is pressure-tested the first time during the procedure, the doctor inflating the stomach with air like a tire when the chest cavity is being flushed. Any leaks are seen as bubbles. Anyway, for test two, we get a sip of water followed by four little cups of grape-flavored intense blue dye (our first drink of anything). They watch to be sure nothing blue comes out our drain. It's not the end of the world if there is a leak, of course, but it'll mean they have to go back in and fix it, which restarts the clock here. Another day or two. So great pains are taken with the initial procedure to make it secure.  Once we've passed the leak test, we're off and running with a variety of clear liquids--variant of which will constitute our sole diet for the next 10 days. Haven't seen them yet, but I expect some chicken broth, water, Crystal Light. No bourbon.


OK, leak check passed! Whew!  Now onto clear liquids. Surprisingly, the water and dye / juice went down exactly as it has for 50 years. Small sips, admittedly, but there was absolutely nothing different in sensation. The grape tasted a bit funny, which could either be the grape or my taste buds courtesy of the antibiotic I'm on (the name of which I do not know).

We got some Gatorade, some warm tea and some apple juice.  So far the two cold drinks have gone down totally normally.  Cool.

I've asked Dr. Aceves to give me a look at the surgical staple they use. I'm curious what it is? Is it a series of individual staples (yes) put in like a sewing machine? Or are they mounted in a strip? He said he'll bring me one.  I'll try to get a picture. This is now a permanent part of me, like a dental bridge or artificial joint.

Some pictures from the drive over:

We drive over in CA and cross into Mexico at Calexico / Mexicali. There ain't much in extreme Southern California.

Mexicali. When we cross the border, there are a couple miles continuous of medical places--more dental than anything, but bariatrics, plastic surgery, optometrists, etc.

Residential Mexicali from our hotel.

The Hospital Almater. Not a clinic, but a full-service private hospital with ER and ICU.

My room, #25. Cozy. Everything is clean and being continually cleaned.

My occupation for three days (a day and a half with my scarecrow). Note the exquisite Omar-the-Tent-Maker couture! I'm thinking of petitioning UPS to adopt this as the new crew uniform. Compression wraps on legs come off today.

Our little ward. 13 rooms.

There's the damage. The two little electrode-thingies at the top are for the EKG during surgery, I think. The bag comes off on Day 3, when it's done doing its job.

More hijinx tomorrow.


Vancouver Voyeur said...

Going strong like a champ! Congrats on these first forays into healing. This is fascinating. Thanks for sharing the process. You could probably guess I like medical shows for the same reason. If my brain had been equal to my desire, I would have become a doctor.

wunelle said...

Quite apart from the obvious benefits I hope to realize, I'm also fascinated at the development of a procedure like this, the figuring out of all the myriad details needed to make it effective and safe.

This place has it down to a routine. Part of the rationale for choosing this place (after deciding to leave the country to make it affordable) was the sheer number this guy has done. As my own Dr. said, I could go to a local hospital and have it done by a very competent doctor who had done three of them. This guy here--Alberto Aceves--is nearing 5,000 total procedures, including 1,500 of the type I got. If anything unusual were to pop up, he'd be the guy to know what to do about it.

So far, so good.

Vancouver Voyeur said...

How did you find this place and doctor?

wunelle said...

I'm piggybacking on the research of a coworker. There are about half a dozen pilots at my company who have undergone this procedure--the VSG--and almost all of them have used this same clinic. My mentor, who had his procedure about four years ago, was unstinting in his praise of this place. I knew that if I were going to pay for it out of pocket I'd be going outside the US (my insurance would pay in theory, but getting approval could take years of supervised diets and counseling, etc.). Going to Mexico cut the costs of the procedure about 60%.

Of course I was skeptical at first, both of the procedure and of pursuing this route to it. But after researching it as best I could and talking to my local WI doctor, I began to PREFER this particular clinic and its doctor because I had a bunch of firsthand reviews and this particular doctor had done more of these than just about anyone else. I searched far and wide and to this day I have yet to find a single negative or even tepid review of this place and its staff. Every report is glowing.

There is a full medical staff here--it's a fully-fledged private hospital--but all bariatric procedures are done by one guy (with an assisting physician). And there's a staff nutritionist, plus the usual complement of internists and anesthesiologists. I felt in VERY competent hands.

Jon said...

Glad to hear all went as planned. Sounds like the whole thing went as smooth as you had hoped. I assume that the 3 day waiting period is just to make sure that the stitches all hold and that there is no infection? Will ypou have to take any meds after you come back or is it only if needed?

wunelle said...

There are no stitches, actually. The abdomen holes are left to fend for themselves--only the drain hole is of much consequence, and they give specific instructions to keep it clean and re-bandage it loosely each day. No ointments or creams or anything.

If this were in the States, you'd be sent home a day earlier. Because it's out of the country (almost all Americans here and some Canadians), they triple-check the staple line over three days to be sure it's secure.

I'll be on a powerful antacid for six months to a year or more, and they send home a few pain meds just in case.

More discomfort tonight, but still not too bad.

Mike said...

One more thing - Nice mandress!

dbackdad said...

Wunelle said, "I've asked Dr. Aceves to give me a look at the surgical staple they use. I'm curious what it is?". lol. That is so you. You are applying the same level of curiosity and attention to mechanical detail as you do when you are on a ship or airplane. I love it!

wunelle said...

Yes, I do rock the mandress in a queer-eye-for-the-straight-guy kinda way ;-)

Alas, my look at a staple has not yet occurred. I'll have to remind him today. For all its radical sound, the procedure is really just a single staple line that results in a stomach of much reduced size. The rest are just details. That in itself fascinates me.

wunelle said...

PS: the surgeon is learning to fly, so we have much to talk about!