Sep - Oct 2013

When to Get Help

By Kathy Scott, RN

Congratulations, you have taken the first step in becoming healthy; you’ve had weight loss surgery. But, what if you have a pain in your right side? Is this normal? Suppose you feel a little winded after walking out to your mailbox this morning. Should you be alarmed? What if you feel constant nausea, but you never actually throw up? Should you call your surgeon if you are able to drink fluids without any difficulty, but the nausea increases after eating solid food? These are all normal questions that postoperative weight loss surgery patients may have during their recovery phase. The question that you should ask yourself is do you know who to call and when to call them? And make sure when you leave the hospital you know how to contact your surgeon.


Now let’s discuss when you should contact your doctor immediately and when you should wait until your follow up appointment.


Let’s start with pain which is a very common issue during the immediate postoperative period. Depending on the type and approach of your surgery (open procedure versus laparoscopic) you may experience some level of pain. Upon discharge from the hospital or surgical center you will probably be given a prescription for pain medication. This will likely be a narcotic of some kind. Your surgeon will want you to use this to help control your pain. But, he will want you to discontinue taking pain medication as soon as possible due to potential side effects. Because these medications slow everything down in the body, it can make you drowsy, slow your breathing, and can cause your bowels to become sluggish (which can lead to constipation). You may get better results if you can begin taking an over the counter medication.  The key to pain control is to keep you moving. If your pain is not controlled with the medication given to you by your surgeon, or if you cannot move because of the pain, then you need to contact your surgeon.


Another potential health hazard is a wound infection. Since the adoption of laparoscopic techniques, the incidence of wound infections has dramatically declined. However here are the signs to look for: any redness surrounding the wound, drainage from the wound, or open areas within the wound. If red areas are present around the wound, it is helpful to outline them with a marker to identify any increase in size. Checking your temperature for at least the first week postoperatively is also very helpful and can aid with the diagnosis of wound infection. If any of these symptoms occur, call you surgeon.


Nausea and vomiting are two other issues that postoperative patients may encounter. But when do you call the surgeon about it? At discharge, you may be given a medication to help with nausea and vomiting. If you experience these symptoms be sure to take this medication to help prevent vomiting. Prevention of nausea and retching is very important for all bariatric patients based on the surgical procedure to prevent damage to the pouch, staple line and slippage of the band. There are many causes of nausea such as from eating too fast, not eating frequently enough, eating too much, drinking with meals, or even lying down after meals. It is important to be mindful of these things while eating, especially in the first few weeks after surgery. You have to listen to your body as you eat. Once the post surgical patient starts vomiting, it can be very difficult to control. If you are not able to control your nausea with medication, call your surgeon.


Finally, you should know the signs and symptoms of DVT (deep vein thrombosis). DVT is a blood clot that usually forms in an extremity, most often the lower leg. Bariatric weight loss surgery patients are at high risk for development of these sometimes life threatening clots. If a patient does develop a DVT and does not seek treatment, this clot can break off and travel to the lungs or heart causing death. If you notice pain in your legs or that one leg is larger in size than the other, you need to call your surgeon or go to the nearest emergency room. If you develop shortness of breath suddenly, go to the nearest emergency room or call 911.


Keep in mind, the two most important things to remember are how to contact your surgeon and which health issues are important enough to call about. When you leave the hospital after surgery, it is your responsibility to ask these questions and make sure you are prepared to respond. Your life may depend on it.