February 27, 2010

The Hospital Experience

Arriving in San Diego/Mexicali: This was a smooth process. I was met at the airport by the driver with my name on a sign, we waited for everyone to get gathered up, then took the van to Mexicali, directly to the hospital. It was the weekend so we had the relief driver, Frederico, who was lovely.

Make sure not to eat after 6am that morning so that they can do your pre-op testing. The pre-op tests were overseen by Yolanda, who is kind of a sergeant at arms there - very efficient and organized, and fluent in English, if you have any questions. (Most folks were English-fluent, other than some of the nurses - even then it was not difficult to communicate.) I do speak a little Spanish, which helped, but the translation guide provided pre-op will give you most of the info you need for a hospital stay. After the tests, Dr Aceves met with us to discuss the surgery and the lifestyle changes we would need to make to be successful. Yolanda gave us an antibiotic and a sleeping pill to take that evening and we paid our surgery fee. Ask for a reciept so you can claim the expense as a medical deduction on your taxes (Airfare and hotel also, I think). We were given a packet of paperwork to fill out at the hotel that night and to bring back in the morning. Then we were taken to the hotel, where check in was arranged by our driver. A bellhop brought us to our rooms and we were free until our 7am pick up at the hotel the next morning. The rooms were very nice. Although the chair in the hospital room unfolds into a bed, I arranged for my dad to stay all through our visit at the hotel. It cost about $60 / night and my patient coordinator made the reservations for us. We just stopped at the desk on our way back from dinner and provided credit card info and that was it. We ate at the restaurant just off the lobby serving Mexican and continental gourmet style food and I thought it was very good - and with the exchange very reasonable also - we spent maybe $70 and I had an appetizer, main and a beer and my dad had a 3-course prix fix which was very good. (Also, you've been fasting all day - so when you get to the hotel you are HUNGRY!) There are a couple other places at the hotel too - an upscale Italian and a cafe style with casual Mexican (Which I might actually have preferred, in retrospect).

Day of surgery: When we got to the hotel, we were moved fairly quickly into our rooms - they are very comfortable with a sofa, a big soft chair, a private bath with shower and the hospital bed. Some English language channels on the TV - they gave me a list of which were English. I think the order of surgery that Dr Aceves uses is Lap Bands first, then sleeves in order of distance of home from the hospital. I live in Vancouver and was the first sleeve that day and went in about 11:00. Before the surgery, Dr Aceves will be in to check in, the anesthesiologist will come in to explain the  anaesthesia procedure, and the hospital internist will pop in also. You'll have an IV placed and be given a mild sedative a bit before the surgery. My surgery lasted almost an hour and a half. I was done at 12:25 and remember waking up in recovery room about 12:30 - I kind of faded in and out a lot - not in any pain, just sleepy, and was returned to my room about 2:30.

I felt pretty good the first day - the morphine from the epidural that they give in addition to the general anesthesia sticks around in your system for about 24 hours. So,  I was up and walking, dragging the IV with me as soon as the epidural wore off. One person who came with me had a lot of nausea and some vomiting that day, but I was fine. Nothing by mouth day one, but I felt hydrated with the IV and didn't have any dry mouth or other problems. I slept pretty well the first night. Dr Aceves and Dr Campos were in a few times to check on me - and this was true every day of my stay - lots of Dr visits - very different from my experiences in the states.

Day 2: Again, a fair bit of walking around - by the afternoon I was feeling pretty lousy - achy and sore and a little nauseated - the morphine had worn off; however, as soon as I asked for pain medication and medication for some nausea I got it and was able to sleep and rest fairly comfortably. Got a sleeping pill that night and appreciated it! This was also the day they do the methylene blue dye test. They'll bring you 4 tiny cups of apple juice with dye in it - you drink it and they'll watch your drain bag to see if any dye leaks out - if you are clear, they'll start you on some liquids: apple juice, tang, chamomile tea. I haven't really had any trouble drinking more or less normally, but for many, tiny sips are necessary. I did urp a bit with one of my first overly generous sips of tea - but that's been it so far. I found that the team in Mexicali is fairly aggressive about pain management, and while I never felt particularly "doped up" all I had to do was ask and appropriate medication was provided. Another sleeping pill that night - also IV was disconnected, although a port was left in my hand for injectable pain/nausea meds.

Day 3: I  took a  shower this morning once the IV was out and it felt great - just ask the nurse for some towels. This is the day they do the x-ray of your stomach. Dr Campos will bring you to radiology and you'll be asked to drink three sips of contrast fluid. A lot of people can't stand this, I just found it mildly bitter - unpleasant, but not horrifying, and it's over pretty quick! You'll see it all on the screen and its pretty interesting. Kind of a boring day really - you'll be feeling more ready to go home. Later you'll receive an envelope with your chest x-ray and the shots of your stomach, a copy of your pre-op labs, and a surgical report to bring home. Also a two week supply of Nexium and 8 of the sublingual pain tablets. I already have Nexium prescribed by my PCP at home and paid for by insurance, so I didn't go to the pharmacy for more. I do wish I had gone to get some of the Supradol (pain med) as it works well and is not as easily available in Canada and the US. This is a good day to go to the pharmacy or have the person accompanying you, if any, do so. It's right across the street from the hospital, so you'll have a short walk - but will need to get dressed in something other than pajamas! They take credit cards - just make sure your bank knows you'll be using the cards in Mexico ahead of time. Once you've had your leak test you'll get chicken broth along with your other drinks - and it tastes really good!

Day 4: Time to go home - you'll need to be up and packed and ready about 7am. Then a longish wait at the border and then the drive to San Diego. We had come from Los Angeles area, so had parked in long-term parking and Ernesto dropped us off right at our car - no need to wait for the airport shuttle.

What to bring "just in case": I brought some Gas-X which I used a couple times and seemed to help. I also brought some chewable Imodium - some folks experience some diarrhea - not a problem for me though (keeping in mind that liquids in = liquids out, so be careful!).

Nurses: All very nice, very competent, with varying degrees of English fluency. There is usually somebody on the ward who is fluent - Lucy was he charge nurse during my stay and was fantastic.

Post-op education
: You'll get some printed info on incision care and post-op diet prior to discharge. Also, Dr Aceves wants you to check in every 10 days for three months and monthly for a year. You can also contact your patient coordinator with questions. I have found OH to be a good resource and also have trolled around the web for as much info as I can find. A lot of WLS info is RNY specific - but there is a lot of overlap in post op diet etc - so much of the info is useful anyway. I'm a believer in supplements, so did a lot of research whilst coming up with my list of vitamins etc.

It's ideal to arrange for follow-up care with your own doctor prior to leaving for surgery. Mine will be checking incisions and then running labs / doing an Upper GI at three months. I'll see him this week and discuss a prescription for Actigall also - one study showed that it reduced the chance of Gall Bladder disease in post WLS patients from 30% to 3%. I'll probably have labs run again at 9 months post-op and then annually - to be sure that none of my levels are trending downward and to catch deficiencies in time to fix them. Dr Aceves welcomes inquiries from your doctor if any questions arise.

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