the post-op life: things i wish i knew beforehand, continued

Grand Canyon, taken in 2008

Just like when I go to the grocery store and realize that I bought wraps, but no lunch meat or lettuce to put in the wrap, I posted about the things I wish I knew before weight loss surgery and forgot several things. Such is life.

Here are a few more I thought of after I posted last time.  Again, these are things that I either didn't know, or my doctor didn't tell me and I had to figure it out myself through experience or online forums, or that he told me without going into depth.

Pain medications may not work as well after surgery.

(Note:  I don't know if this applies to all weight loss surgery, or just gastric bypass (which is what I had), so this may not apply to some people.)

This is a tough one. I definitely didn't know this ahead of time, and no one told me.  I was, however,  told I couldn't take NSAIDs, such as ibuprofen or aspirin, anymore, because they weaken the stomach's ability to make acid, which can lead to ulcers.  I figured I'd just be taking acetaminophen instead. No big deal. I took that before surgery with no issues and it worked for me. And anytime I need a pain reliever these days, that's what I take. I find, however, that it isn't as effective as it used to be. It kicks in fast, but it doesn't work nearly as long as it used to, which usually leads to me having to take more. I worry about liver damage, so most of the time I try to just ride out whatever is bothering me, such as a minor headache. Sometimes, though, I really need something more. I'll either take three acetaminophen (I know, I know--I'm not supposed to take more than the dosage), or I'll throw caution to the wind and take two ibuprofen. I try not to take them, since  but sometimes I need to. I try to limit to no more than once a month or so, and only when I really need it. My orthopedic doctor prescribed Celebrex for my back problems, which is supposed to be taken daily; however, for a long time I took it for a few days, skipped a few days, and then started again. I was worried about ulcers. My new bariatric doctor told me to take Protonix (it reduces the production of stomach acid) each day I take a Celebrex and I should have no issues, so that's what I'm doing now.

Also, if you've had gastric bypass, prescription pain meds, like Vicodin or Percocet, can hit you much harder than before surgery. I found this out the hard way when I took liquid Roxicet for some pain I was having. I wasn't far out from gastric bypass surgery (maybe a few months?) and I still had the Roxicet that was prescribed to me, which I never used, so I decided to use it. (I think I was having back pain at the time.) Knowing that the pain meds could hit me harder now, I took half the recommended dose (2 tsp. was the prescribed dose and I took 1 tsp.). Well, that was too much--about twice what I could handle. Basically, I was really worried that I'd die in my sleep because of how it made me feel--stabbing stomach pains, very lethargic, blurred vision, dizziness, slowed heartbeat and breathing), and my husband was asking if he should call 911; I'm pretty sure he watched me for awhile before going back to sleep. I was fine after about a half hour, but it was very scary.

Now, anytime I have to take a narcotic, or anything else that's prescribed, I start with about 1/4 of the recommended dose until I know how it affects me. I've learned that half of a 5/325 Percocet is just right. Anything more and it completely knocks me out, but not before giving me an awful stomach ache. The one GOOD thing about this?  A prescription for 20 Percocet pills lasts me more than a month, assuming I take half each night. And since I only take it when I truly need it--because Tylenol isn't working--it lasts me way longer than that.

If you want to move to a different bariatric surgeon's office after surgery, it's going to be very difficult.

I found this one out the hard way, too, and it's something that never would have crossed my mind to ask. Although people may switch primary care doctors, eye doctors, dentists, etc., most people don't switch bariatric surgeons after surgery.

A little less than a year after my weight loss surgery, I decided to move to a different part of the state. I stayed with my surgeon, though, because I was happy with him and had no reason to switch. Sure, it was a pain in the ass having to drive almost an hour to his office, but I was OK with it since it was only going to be once per year. I went to my one year follow-up about six months after I moved and noticed that every single employee in the office, except the doctor, was new. I thought that was a little strange. It seemed as though he did a complete house cleaning, but I didn't ask.  Not my business. A few months later I went for my annual blood work, and never heard another word. I was annoyed, but figured the results showed no issues and that's why they didn't call me to discuss. Then another few months go by and I get a letter in the mail that the practice had been sold to a surgical franchise and my doctor moved to Texas to teach...two months prior! It was frustrating to not know ahead of time, but I rolled with it. When it was time for another annual checkup I started looking into the new practice and, surprisingly, it isn't focused on bariatric patients. They do some bariatric surgery, but it seems that facial plastic surgery--cosmetic stuff--is their main focus. I decided I really didn't want to go there, and the drive was a PITA anyway, so I started looking for a surgeon in my area. 

Finding a surgeon that would take a post-op patient was extremely frustrating and near-impossible. It took me over a year to find someone that would take me. To be fair, I started and stopped looking several times because of the frustration, or just because I didn't want to deal with it and I didn't have any issues I needed to follow up on. I was told by everyone that they're accepting only pre-ops--people who are looking to get weight loss surgery. I got the impression that they really aren't interested in post-ops. I got serious last year and finally found someone that would review my file and possibly take me. I emailed back and forth with the surgical program (not the doctor's office directly) and they had me get my files sent to them from the old doctor. I sent my files over and then...nothing. For months. I followed up earlier this year and it turns out the person I sent my files to left shortly thereafter and my files never made it to the doctor. They went searching and found them. I was told to give them a couple weeks to have the doctor review them and they would call me to schedule an appointment. They didn't call, of course.  I had to call them. (But that's always the way with doctors' offices so it didn't really bother me.) I called and they said they'll take me, and I scheduled an appointment.

I went for that appointment a few weeks ago and I really like the new doctor. He spent at least 30 minutes with me (almost unheard of with any doctor nowadays!) and went over my file, my current health, etc. Asked lots of questions, and gave me time to ask my own questions, which was nice. He explained anything that needed explaining. He ordered bariatric blood work, which is way more detailed than standard blood work. (As opposed to the lab drawing one or two vials of blood, bariatric blood work requires usually seven to nine vials.) During the visit I thanked him for taking me on as a new patient and explained the difficulty I had in finding someone who would take me. He confirmed my suspicions and told me that the money isn't in the post-op care, it's in the surgery itself, and lots of doctors don't want to bother with a post-op patient. He said he's probably giving me too much information, but wanted to explain. I wasn't surprised and I was happy he told me that.

I now know that if I ever move again, I am probably going to have a really tough time finding another bariatric doctor. But I don't plan on moving, so hopefully that will never come up.

I feel like I could talk forever about the reality of the post-op life, but I think this will do it for now.