LT'S BLOW-BY-BLOW SURGERY STORY - REV'D

[Guest guest]

Friday, May 26, 2000

Hi Ya'll!

The *worst* part of the surgery for me was being without a computer!

LOL! (but entirely true!)

Stats: I'm 47 years old, 5'4 " tall, starting weight 249, surgery

date May 18, 2000, current weight 238 (1 week later). I lost 17

pounds in the 6 weeks before surgery when I had gotten up to an

all-time record high of 265 lbs.

Here's my blow-by-blow description of how my trip to Oz went for me:

GETTING THERE:

I'm from Alabama and Dr. Rutledge requires out-of-town patients to

attend one clinic prior to surgery. Since he is holding clinics on

Tuesdays now and my surgery was scheduled for Thursday, May 18, 2000,

I arrived in Durham on Monday, May 15th, in order to attend the

Tuesday, May 16th clinic.

For anyone travelling alone, I was solo and it is definitely do-able.

I would have done a few things differently but my original plans

were made when I thought I would be accompanied to Durham, which got

changed at the last minute. Mainly, I would have stayed someplace

closer to the hospital and not fooled with getting a rental car, but

I was able to drive easily two days after surgery so it wasn't really

a big problem.

I got my airplane reservations from lowestfare.com for $130 ($156

after taxes and surcharges were added), with less than 7 days'

notice, round-trip from Montgomery, AL to Durham, NC on Northwest

Airlines.

Being on the conservative side, when I made my reservations, I

planned to stay in Durham for 5 days after the surgery, so I was in

Durham from Monday, May 15th through Tuesday, May 23rd, when I flew

back to Montgomery and then went to a friend's house in Florida to

visit until today (Friday, May 26th). I could easily have left either

the day after surgery or two days after surgery with no problems.

I stayed at Extended Stay Inn on Tower Boulevard. The cost is $272

(total, after taxes) for one week for one person and it is about $20

more for the week to add another person. The room is on a par with a

Days Inn or Red Roof Inn -- not spartan and ugly, nice but not plush.

It has a kitchen and it is located across the street from South

Square Mall and within 2 blocks of a 24-hour Kroger and several

restaurants and fast-food places.

However, I just read today where someone found a *much* better deal

at 1-888-Medstay, that has a free buffet breakfast, lunch and a pool,

so I'd try that first!

Rental Cars: The best price for one-week on Rental Cars was from

Dollar Rental Car at the airport. You could get a small truck for

$149 a week or a small car for $172 for the week. I lucked out

because they were out of small cars so I got a mini-van for the same

price for the whole week and 1 day I was in Durham.

======================================================================

HINT #1: BEFORE YOUR LEAVE, CALL YOUR HOTEL AND GET *SPECIFIC*

DIRECTIONS TO YOUR HOTEL FROM THE RALEIGH-DURHAM AIRPORT AND WRITE

THEM DOWN AND TAKE THEM WITH YOU. My plane got in at 11:30 at night

and I forgot to bring my directions with me. The rental car place

gave me directions to downtown Durham, but I spent about 3 hours

driving around in the middle of the night, looking for *anyplace*

open just to get directions from downtown Durham to my hotel. I

finally ended up being shown how to get there by a security guard

from the Marriott in Downtown Durham.

======================================================================

CLINIC:

I showed up at Dr. Rutledge's office on Tuesday morning, May 16,

2000, for the 9:00 a.m. clinic. His receptionist gave me my file and

directions to go to a building just past the hospital, a few blocks

away.

The clinic was held in a small room in what appeared to be a

medical-annex type building. Dr. Rutledge spoke at the front of the

room. Behind him was a blackboard and above him and to one side was

a video screen.

There were about 35 people, including potential patients and some of

their family members, in the room, seated in plastic chairs. Some of

the chairs don't have arms on them but some do. Don't get there last

if you want a chair without arms . . .

In the back of the room, Debbie, Barbara, and two other women whose

names I didn't get, all of whom work for Dr. Rutledge, worked on

getting patient information, weights and waist sizes from everyone.

I was given another Patient Information Form to fill out.

======================================================================

HINT #2: Print off TWO copies of your patient information sheet when

you submit it to Dr. Rutledge, one for you and one to take with you

to your clinic visit, otherwise, you will get to fill out *another*

Patient Information form (just like the one on the webpage) at the

clinic.

======================================================================

I was weighed (249 lbs., argh!) and my waist was measured (45 inches.

Sigh.)

Dr. Rutledge calls on each person in the room, asking them to

introduce themselves, then he answers any questions they may have.

He illustrates things using the blackboard. Towards the end of the

clinic, he shows a videotape of an actual Mini-Gastric Bypass being

done, as he explains what you are seeing (which was very helpful for

me since I had no clue what organs were what). It is remarkable how

tidy the inner organs are and how skillfully Dr. Rutledge can work

with those tiny little tools, looking at a camera image of what he's

doing. He also explains why the MGB is readily reversible. The MGB

takes about 35-40 minutes and a reversal takes approximately 1 hour.

Both are done laparoscopically so there is very little blood loss, an

average of 1 day in the hospital, and a very fast recovery time.

Dr. Rutledge then goes into an area of individual patient rooms and

each patient is called back to speak with him individually.

My questions were:

" After the MGB, does the larger part of the stomach that is cut away

from the new small stomach growl or send hunger signals to the brain

and if not, why not? "

Dr. Rutledge explained that the stomach does not send hunger signals

to the brain. It is the small intestine that does that (and

approximately 6 feet of that is bypassed by the MGB). I didn't think

to ask if the bypassed small intestine sends hunger signals to the

brain since it would be empty all the time, but I think the cutting

of the vegas nerve that occurs during the surgery alleviates that (I

may be wrong on this point). The bypassed stomach doesn't growl

because it doesn't have any air left in it. It also does not

atrophy, which is one reason why the surgery can be reversed.

MISCELLANEOUS, DAY BEFORE SURGERY:

You are supposed to wash with Hibiclens the night before surgery and

the morning of surgery. This is a red-colored liquid cleanser that

will pretty much permanently tint your washcloth pink (good thing

you're staying at a hotel, right?) For those not staying at a hotel,

don't use your good washcloths for this.

I found Hibiclens in a small bottle for $3.59 and a somewhat larger

bottle for $6.79 at the Drug Emporium next to Circuit City, across

the street from the Tower on Tower Boulevard in Durham. The smaller

sized bottle would have been sufficient.

Remember not to eat or drink after midnight the day before your

surgery.

Call Durham Regional Hospital after 3:00 p.m. the day before your

surgery, ask for " whoever schedules surgery, " and they can give

you the exact time you are scheduled for surgery. You are supposed

to get to the hospital 2-1/2 hours before your scheduled surgery

time.

THE DAY OF SURGERY:

I parked my rental car in the patient parking lot in front of Durham

Regional Hospital. There is no charge for parking there. I walked

through the main front door. There is an information booth just

inside the front door and I asked where a pre-operative surgery

patient should go. I was directed to a waiting area on the third

floor. There was a receptionist there with a sign-in sheet which was

used to call patients for processing. I only had about a 10 minute

wait before I was called. While I was waiting, I met the woman who

was scheduled for surgery with Dr. Rutledge before me. I was

scheduled to be the second one of the day.

When my name was called, I was directed to a small room just behind

the receptionist's area. A lady asked my name, address, and

insurance information. Dr. Rutledge stuck his head in to say " Hi. "

Next I was directed to another lady who made a patient i.d. bracelet

and put it on me and then led me to the next area.

I found myself in a fairly large room with nursing supplies and

counters down one wall, with patient cubicles formed by large

curtains hanging from ceiling tracks going down the other side.

Each patient area had a gurney with sheets on it. A nurse gave

me a patient gown, surgical stockings and some footies to put on.

I was told to remove *everything* before putting on the gown.

The surgical stockings are thigh-high heavy-duty support hose.

These stay on until the day after surgery.

The gown tied in the back and snapped at the neck and down the short

sleeves. It was plenty roomy and large enough, but it didn't tie

well in the lower back, so that if I got up and walked around in it,

my bare behind was flapping in the breeze. I quickly parked myself

on the gurney with the gown tucked around my hinterparts and stayed

there.

Shortly, a nurse came and took my temperature, blood pressure, and

used a nifty little gadget to stick me in the finger to get some

blood. That did not hurt one iota (a *big* improvement over the days

when they used jagged metal for finger sticks, let me say!)

I was told to put anything I brought with me into a bag and the bag

was marked with a sticker with my patient information to be sure it

got to my room (it did). I had brought my Walkman, some books, a

gown, and my purse.

The nurse handed me Dr. Rutledge's Consent form to read and fill out

then. Dr. Rutledge requires a short paragraph to be written below

each of the items on the consent form so it takes a little while to

complete it.

======================================================================

HINT #3: Don't take your jewelry and purse/wallet to the hospital. If

you have a family member with you, leave these with them; otherwise,

you should check them with the hotel and have them put them in a safe

for you. It's a nuisance to keep up with them at the hospital and

you are going to be asleep a lot, plus your bag of items can easily

get misplaced from the time you check in at pre-op and get moved to

a room. They will *not* be insured against theft if you just leave

them in your hotel room, either.

======================================================================

Shortly, a nurse came for me and wheeled the gurney and me to the

surgery staging area. This is another room, just outside the surgery

rooms, where patients for different doctors are lined up

side-by-side, waiting their turn for surgery. It's a pretty plain

room with a nursing station in the middle. It seems that patients

are expected to be laying down so I did.

Now, this is the part I dreaded most. I've had several surgeries and

I've given birth to three children, and each time, I had to have an

I.V. I knew from these experiences that the I.V. needle is usually

stuck in the back of the hand between the thumb and wrist -- where

there are hundreds of nerve endings -- and it hurt like hell and

beyond.

Pre-Op Nurse Sheila Weeks sets up all the I.V.'s. She is clearly

expert and she has a wonderful technique. She first gives a small

Novacaine injection into the hand. This hurts a little (not much)

and it is wonderful, because I then did not feel the I.V. needle

(which is quite large) *at all* when she put it in place. I did not

have so much as a tiny bruise at the site when the I.V. was removed

the next day, either. Truly wonderful. Thank you, Sheila!!

Before anyone goes sticking an I.V. needle in you, particularly if it

is not Sheila, make sure they are going to give you the Novacaine

shot in the hand first.

Presently, the Anaesthesiologist and shortly thereafter, the

Anaesthesia Nurse, stopped by to see me. This was a good time to

mention any drug allergies. Both of them asked me to open my mouth

and say " Ah, " so they could see if I had a good airway. (Anybody who

knows me knows I have a big mouth and plenty of airway!)

It didn't seem like 2-1/2 hours had zoomed by, but before I knew it,

I was being wheeled on the gurney into surgery. There seemed to be

several people in the brightly lit room and everyone was wearing blue

gowns over blue pants, with blue hair covers and face masks (E.T.

phone home!). Dr. Rutledge was standing off to one side with his back

to me. I think he was washing his hands. I was told to slide

sideways off the gurney onto the surgical table (which is narrow).

It's hard to see much laying flat on your back, but I Dr.

Rutledge was there because he immediately started in with his usual

chipper chattering. Assured that at least I was in the right place,

I laid my head back and relaxed. Momentarily, a gloved hand appeared

and put a mask over my nose. I started breathing into it and conked

right out. The gas didn't stink or have any odor to it at all that

I could tell.

I woke up in the post-op recovery room. Things are a little hazy but

I had no tubes in my nose or anywhere else. There was a nurse next

to me saying things like " Your oxygen isn't high enough. Breathe

deep! You must take deep breaths! " So I did. I'm laying there

sucking enough wind to take the chrome off the bedrails. (I found out

later that they seem to say this to everybody so when you wake up,

just start breathing deeply!)

At some point, I remember somebody, I think it was Dr. Rutledge,

saying " Your operating time was 37 minutes. "

As I got more awake, within what seemed like minutes, I was being

wheeled down a hallway to my room.

Lori Honour, an angel who lives in the Durham area and is having her

surgery the end of May, had come to wait for several of us who were

having surgery that day and she was the first person I saw when we

got to what was obviously the hallway with patient rooms. I thought

we were just a few feet from her (she says I was actually at the

opposite end of the hallway) when I hollered out, " IT WAS A PIECE

OF CAKE! " And, indeed, it was.

DRUNK AND DISORDERLY:

The anaesthesia had made me goofy and drunk-like because I was in

high spirits, to say the least, when I got to my room! I don't

remember getting off the gurney and into the bed but I did. The

nurse came and gave me some pain medication. I wasn't feeling any

pain at the time, at all. Within a few minutes, I got up and went

into the bathroom which was just a few feet from the bed. I called

over my shoulder to Lori, " You've seen a fat ass before, I know! "

since it was useless trying to get the gown to cover mine and I was

laughing too hard to care anyway. I fell asleep sitting on the

toilet three times. Fortunately, Lori would wake me up. I'd laugh,

try to pee, then fall back asleep each time. I finally succeeded and

then got back into bed. The nurse put some plastic air-pumped sleeves

on my legs. These automatically pump air into them every few minutes,

gently squeezing the legs, then releasing the air. These are to

prevent blood clots in the legs. I wore those all the first day and

night after surgery.

Right about that time, a friend called me on the room phone.

I tried to talk, but fell asleep on the phone.

The next time I woke up, about 3 hours later, I had some pain and

discomfort. This is mostly from the gas that is blown into the belly

during surgery so the doctor has room to work and see what he is

doing. This gas is *not* like " having gas " when you get the burps or

farts. It gets in all sorts of places, like up under your ribs and

in your shoulders and there is a lot of it and it is really

uncomfortable. It's not terrible pain but it is painful and annoying

and at the same time, you're tired from the anaesthesia, so you feel

pretty washed out.

The gas *will* go through membranes, though, so it will go to your

throat and lower intestines on its own. If you can force

yourself to burp or pass gas (the men ought to be good at this. Just

remember your Boy Scout campouts), you can get rid of it faster. I

put my best efforts into it and within about 6 hours after I got out

of surgery, I was feeling pretty good. I had the burps and passed

gas more frequently for several days, though, and I also got the

hiccups a few times after eating.

======================================================================

HINT #4: Keep your bed in as much of a sitting position as is

comfortable for you. This helps get the gas up faster and it

doesn't put tension on the 5 wounds with a staple in each that

you will have from the surgery. Lying flat on your back keeps

the gas under your ribs and it also stretches on the incisions

so it is a lot more uncomfortable.

======================================================================

Good pain medications are available. I preferred to get a shot of

demeral with phenergan every 4 hours, which is what I got the first

day and it worked great. Other people get a " pain pump " which lets

you hit the pump when you need pain medication. Ask for the strong

pain medications the first day. They will alleviate the pain and

you will be able to get up and walk and move around, which will

speed your recovery. By the second day, the pain was markedly

less for me. I didn't have any pain medications after the first

day.

Lunch and dinner the first day and breakfast the next day at Durham

Regional consisted of a clear broth (be sure you get salt), jello

and 4 ounces of fruit juice. I would keep the broth from breakfast

to lunch, sipping it as I could and I saved the jello and fruit juice

to take back to the hotel. Just the broth was plenty. I never felt

hungry. I was extremely thirsty frequently. My mouth would go so

dry my lips stuck to my teeth. So I guzzled a lot of water and ice.

POST-OP:

I was discharged from the hospital the next morning after surgery.

After Dr. Rutledge came by, I remembered something I needed to ask

him and I actually ran down the hall (no pain at all) to catch him.

Since Dr. Rutledge's discharge instructions say, " No driving for two

weeks " (until you are off pain medication), and I was concerned about

the effects of anaesthesia, Lori came and took me to the hotel and I

left my rental car at the hospital. Since I had five days until my

plane left, I spent the rest of that day lounging, but by the next

day (Saturday), I went with Lori to a support group meeting at the

hospital and drove the car back to the hotel. That night, I went to

Krogers to buy some juices. Sunday, I went to the mall and went

shopping. Monday, I went to the mall again and packed my things for

the early morning plane on Tuesday. I hefted my 80 pound suitcase

into the mini-van, drove the 25 miles to the airport, checked the

rental car back in, rode the shuttle over to the airport and hefted

the suitcase another time to get it checked in. I had a long walk in

Memphis to change planes and it was uneventful. When I got back to

the Montgomery airport, a friend was waiting to pick me up and we

went to Florida, where she lives, for three days. We went shopping

and generally did ordinary things and I had no problems at all.

I haven't had any problems with dumping, nausea, or vomiting and I've

had milk, a bite of double-fudge ice cream, jello, soups (including

some creamy mushroom soup the other day and chicken vegetable soup

today), apple juice, orange juice, cranberry juice, and grape juice,

and a banana in the week since my surgery. I haven't been hungry.

I got a couple of cravings in the past day or so, but nothing

serious.

I haven't had over 600 calories in any given day and I am usually

averaging about 350 calories a day.

At the end of the week, I'd lost 11 pounds and 1 inch off my waist.

So far so good.

Also, let me mention here that before surgery, I received replies to

my queries from 94 of Dr. Rutledge's patients and the majority of

them related that they had discomfort the first day and little or no

pain, nausea, etc. thereafter, the same as me, so my experience is

very much the norm, not the exception.

Dr. Rutledge, you're the best!

Kind regards,

( " the Barbie Wannabe " )

email: lindatATfourlane.com (replace AT with the @ sign)

website: http://www.fourlane.com/lindat

Stats:

47 years old

5'4 " , 249 lbs.

Surgery date: May 18, 2000

May 26, 2000: 238

June 6, 2000: 234