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need advice about how to prepare for bowel resection??

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Posted 1/9/2008 12:18 AM (GMT 0)
 Hi! I just stumbled upon this website and it looks quite helpful. I've never joined a chat site before. I have had crohn's for years and will be having my first surgery this month, just waiting for the surgery date. Just wondering if anyone has any wonderful wisdom regarding diet and/or supplements to take before surgery to help the healing process?  What do they give you to eat or drink in the hospital after surgery? Just have no idea what to expect? Help!

Currently taking pentasa 500mg 2 X3 a day

Resection will be done in the ileum to remove stricture.

Posted 1/9/2008 1:21 AM (GMT 0)
Hello and Welcome. I'm sorry you have to be here but glad you found us. You will find a tremendous amount of information and lots of people with lots of experience dealing with all aspects of this wonderful disease. I can't really help with what to do to prepare as far as supplements and the like, not something I did. You don't say how old you are or your living situation. But if you are the primary food source for your family (the cook) prepare by stocking your freezer with some homemade meals that will be easy to reheat and soft on your healing insides when you get home.

As far as the hospital recovery, don't try to be a hero. Take the pain meds. You need to get up and moving, that is what will get your intestines moving again. But you will be sore, so take the meds. Don't wait for the pain to become unbearable, if you do, it is harder to get it under control. The first things they will give you will be clear liquids, then full liquids and then soft foods. Depending on how long you are there you may get up to actual food food, like baked chicken or pasta. You will want to have soft well cooked foods for a while. Nothing raw or crunchy, but you will be able to progress. If something bothers you, just back off for a day or so and try again.

I like to have a touch of home with me, so I like to bring my own pillow and pillow cases. They are softer and just make me happier.

As the date gets closer, I'm sure you will have some very specific questions, please come and ask away. There is always someone here. I hope it goes well for you and that you have a speedy recovery.
Posted 1/9/2008 4:58 AM (GMT 0)
Thanks for the reply! Your advice is helpful. My own pillow sounds like a great idea. I'm a 40 year old housewife raising two boys, so stocking my freezer with meals is definitely on the top of my list to do. The surgeon has instructed me to go off the Entocort before surgery. The granules inside the pills build up inside the bowels causing major problems during surgery. So not feeling very well since having gone off the entocort. Did your energy level increase eventually after having you resections done? Or does this just seem to be on of the lovely symptoms to always expect with cd? Could you eventually eat raw and crunchy foods (like salads) after your resection? I just keep hoping that once this stricture is gone I might be able to eat these things once again (on good days of course).
Posted 1/9/2008 5:48 AM (GMT 0)
Welcome to the forum! I just had an ileocecal resection which is basically removing diseased ileum and ileocecal valve. I had a foot of my terminal ileum removed because I had 3 strictures...so our surgeries may be similar. In terms of what to expect:
Before Surgery:
Bowel prep- do this so that your doc doenst have to work through stool and bile..makes them happier
Epidural- if they offer this to you as a pain management TAKE IT...I was nervous about it at first but I am so happy that I decided to take it. You feel a lot less pain in the incision site and you also dont feel the uncomfortable catheter as much either
After Surgery:
You will wake up hurting pretty bad, and like said before dont ignore your pain...take the pain medications that they offer. These are there to help you during recovery. Also get up and walk as soon as you can to get your guts moving and your recovery process going. It will hurt like heck to walk, but just do it. Try and get a lot of sleep while you are in the hospital because your body has just been through a lot and needs some recoop time. Dont ask for pain meds when you are deep into pain...try to stay on top of it so that you arent playing catch up with the pain management...not fun at all.
I was in the hospital for a week, but it is also because I had an open surgery and had some issues with pain management. I am almost a month out from surgery, and I am going to be honest I am still tired and still have days where I feel crummy. However I also got a stomach bug last week which didnt help and had a minor complication..which put me back in the hospital. I have known a lot of people who have done this surgery, and it seems to help many of them. It is about a 6 week recovery, but it doenst mean that after 6 weeks you will feel completely normal and ready to run. Your doc may take you off of crohns meds for a while so you are able to heal, but then he/she may start them up again to prevent a flare.
BEST OF LUCK!!!
Posted 1/9/2008 2:42 PM (GMT 0)
My best tip to add to the above is be sure that you take some kind of maintainence med after your surgery to help keep you in remission. Good luck with your surgery, and I hope it brings you years and years of remission. God Bless!~
Posted 1/9/2008 4:03 PM (GMT 0)
Thanks for the tips! I never thought about a catheter, ugh..never had one yet. I'm not sure what med. management they will want me to go on afterwards... Pentasa seems to help alot. For so many years I was just passed off as having IBS so that is when all of the
damage would have started in my terminal ileum. I really want to give alternative meds, mangosteen juice, acupunture etc. a good try afterwards to help with remisson. Any of you have any experience with those alternatives? Thanks again for your replies, it really help to talk.
Posted 1/9/2008 7:35 PM (GMT 0)
I'm assuming that you're going to have a standard bowel resection, not a laparoscopic operation. Based on that assumption...

Treat yourself generously with the pain meds for the first 4 days, but after that you need to get off them rapidly. There is a device that can be attached to your wrist that lets you administer your own pain meds in mini-doses. This is much better than getting an injection once every 3 hours. You actually wind up using less pain medication this way. Another way is a slow IV drip added to your IV bottle. If you need an injection, ask for it IM rather than IV - it will be absorbed more slowly that way. I've found that straight IV injection of an opiate is too strong - makes me faint, and the benefit is short-lived.

The catheter thing isn't so bad - I hardly even noticed it. It will probably be removed by the second or third day, just in time for you to start walking. What I hated most was the NG tube - it has to remain in place until your first bowel movement (about 4 to 5 days).

And yes, lots of walking is important. The doc will probably tell you that. They want you to get out of bed as soon as possible. From my experience, it will be at least 3 days before you can walk, and very unsteady at first, but after one week you should be good to go. Walk several times a day, as much as you comfortably can. This is important for your recovery and to avoid adhesions from forming.

Just a little advice on post-op diet. It's not unusual to have a lot of diarrhea while recovering from a bowel resection. I found a pretty good diet was white rice, overcooked so that it's more like porridge, with something very soft added for protein (perhaps an egg, or mashed tuna (no oil).

Maintenance meds - I'm doing OK with sulfasalazine. Even better is mesalamine, but it's a lot more expensive. Side effects are minimal, much less than Pentasa, but I'm not sure what you'll need. I had some headaches and upset stomach with the sulfasalazine at first, but that has gone away. Had no side effects with mesalamine.

I take supplements. Vitamin A (fish oil type, not beta-carotene) once daily, plus MSM. Avoid caffeine and hot spices.

best regards,
Robert
Posted 1/9/2008 10:51 PM (GMT 0)
Hi Robert! Thanks for your unfortunately very well educated experience advice. You sound like a pro. The surgeon did mention that he would be attempting to do the surgery by laparoscope, depending on what he actually finds when he goes in. He also said I would probably be in the hospital for about 3 days minimum. So I guess its wait and see. Mesalamine - I'm not familiar with that drug..is it an anti-inflammatory? Does it contain sulpha? (allergic) Thanks again!
Posted 1/10/2008 2:55 AM (GMT 0)
I had a lap-right-hemi-colectomy (removal of half of my right colon laparoscopically) last November. Good advice from all the above. I also came across this article before I went in. It's about chewing gum to help the intestines wake back up after surgery and get you out of the hospital quicker. I did it and don't know if it helped any. I got out of the hospital on the fifth day which seemed pretty standard. Interesting nonetheless.

http://news.bbc.co.uk/2/hi/health/4725054.stm

 

Post Edited (Driver37) : 1/9/2008 8:00:59 PM (GMT-7)

Posted 1/10/2008 3:24 AM (GMT 0)
Hello,

I just had my first ileocolic resection performed laparoscopically this Monday.  I was given a 50/50 chance of having it performed laparoscopically vs. regular incision, and I guess I had a lucky day.  Leading up to the surgery my surgeon put me on a liquid/soft solid diet along with antibiotics (Cipro and Flagyl) for three weeks.  This seemed to help significantly, as the swollen mass that she had felt at my pre-op appointment had reduced significantly by the morning of surgery.  I tried to force myself to drink some Boost leading up the surgery to ensure that I had ample nutrients beforehand.  My surgeon did say that I was very dehydrated, so keep your liquids up.  And, I did need a blood transfusion afterwards, but all in all, I have been recovering very well.

My surgery was on Monday morning - I was in bed for the rest of the day, and used the morphine pump sparingly, as my pain was tolerable, and I have heard that it slows down the digestive tract.  On Tuesday morning, I woke up and went for a walk - this made me feel a lot better, and so I ended up staying out of bed the whole day and alternated between walking and sitting in a chair.  I only used the morphine to help me get out of bed that morning.  This morning, Wednesday, I used the pump once, and then had it disconnected.  They also removed the urinary catheter.  I have been walking around, and am on a clear liquid diet and am just waiting to pass some gas so I can graduate to some soft solids!

In terms of other preparation, try to clean up your house (vacuum, dust, etc.) before you leave, as it will be difficult to do those things right after you get home.  If you live in a multi-level home, hopefully you have a washroom on both levels so that you can avoid running up/down the stairs each time you need to go.

In terms of medication, I was on Entocort and Imuran prior to surgery (with Cipro and Flagyl added in for the 3 weeks prior), and am expecting to go home with Imuran only as my maintenance drug.

Good luck!

Posted 1/10/2008 3:36 AM (GMT 0)
I was diagnosed with Crohn's in 1994. Had been in remission until the beginning of 2007. I had three strictures and I ended up having a resection done this past October to remove those parts of my small intestine.

I had laproscopic surgery done so I ended up with a one two inch incision and two other very small incisions. They gave me a morphine drip for pain and it made things more bearable. I ended up with pneumonia two days after the surgery. I am not sure what caused that but I also have COPD and that may have been it. Also, for about 3 weeks before the surgery, I started a liquid diet. I think maybe the decrease in nutrients may have had something to do the pneumonia too.

One of the best things to do is to get up and out of bed as quickly as possible. The nurses had me walking the day after the surgery. It took several days for my digestive system to start working again. No bowel movements or passing gas during this time. Once things started to move, they took me off of the IV and put me on clear liquids, then full liquids and then soft food which included pasta.

One other issue that I had while in the hospital was that I was still taking 8 500mg Pentasa capsules per day every day. It felt like whatever is in Pentasa was just building up in my digestive system because I was not having any bowel movements. I just felt very uncomfortable and after several days I ended up telling the doctors that I decline to take anymore Pentasa. Once everything started moving I started on the Pentasa again and now take it for maintenance.

It took me several weeks to really feel back to normal again. One great thing about having the surgery done is that I am able to eat somewhat normally again without the gurgling and noises that my gut used to make.

Good luck to you with the surgery.
Posted 1/10/2008 3:39 AM (GMT 0)
Sounds like you're doing really well CdnCrohnie. You'll be up and out of there in no time. Take it slow though when you get home.

Oh yeah, I might add. The worst part for me was the IV pump beeping all the time when it ran out or got stuck and being woke up in the middle of the night for blood pressure check, etc. I would get my last check of the night at about 9 or 10 pm and then they would come back in at 4 or 5am. And between that time the IV pump would usually wake me up at least once, beeping for some reason, and I'd have to page the nurse which would could take some time. Meanwhile the thing continues to beep and I'd have to keep hitting the mute button keeping me awake all the while. You'd think they'd want you to get as much sleep as possible to help the recovery. Maybe it was just the hospital I was in.

Just thinking about it I can hear the beeping in my head. I could have PTSD from this. Just kidding tongue . But seriously, it was horrible.

Post Edited (Driver37) : 1/9/2008 8:43:57 PM (GMT-7)

Posted 1/10/2008 4:32 AM (GMT 0)
Hi CdnCrohnie! You are doing amazing after your surgery! Way to go! If my surgery goes like yours so far, I will be a happy girl!!
Thanks for all of your advice. My doctor has not said anything to me about going on a liquid/soft diet weeks before surgery? I am going to the hospital tomorrow for the pre-op appt. so I will ask then, thanks! Yes, the major thing that is stressing me out right now is trying to get the house organized and cleaned etc. and fill the freezer with meals for the family. Its so hard having CD and trying to be a mom, wife etc.
good thing I have alot of support. :)
Posted 1/10/2008 4:36 AM (GMT 0)
Driver37 - Thanks for the gum tip! I will stock up on gum before I go to the hospital! Very interesting article.
Posted 1/10/2008 11:24 AM (GMT 0)
There are a lot of points made in all of these posts. And I'm glad you have a pre op appt. with your doctor today and you will be armed with lots of questions to ask. The thing to keep in mind is that all surgeons, hospitals and patients are different. So what is standard for one may not be the same for another. I had the same surgeon for all 3 of my resections, I had an NG tube for the first two, but 2 years later the surgeon had decided to no longer use them, so no NG tube. After reading all these posts, some are contradictory, so just be prepared to listen to the way your surgeon usually does things.

And some one said they were on mesalamine and you asked what it was, it is the generic name for Pentasa.

Good luck and keep us posted.
Posted 1/10/2008 3:43 PM (GMT 0)
Suzanne, thanks for taking the time to reply, this forum is very helpful. But, yes I will consider all of the advice and insight..it does load you with alot of questions to ask the doctor...but you are right everyone's situation is so different. Wish me luck at my appt. this morning!
uggh...two hour drive.
Posted 1/10/2008 3:46 PM (GMT 0)
I had my first bowel resection done in July 07. It was supposed to be laparoscopically but once they got in there, it was worse than expected and I ended up with a 7 inch incision down the middle and 2 one inch incisions on the side. I didn't really notice the catheter and they took it out on day 2 (I had my surgery on a thursday but didn't get back to my room until 10pm that night so I count Friday as my first day in the hospital). I am a little hard headed and didn't want to take the pain meds as much as I should have and everyone is right that it is MUCH harder to catch up to the pain afterwards. So if you need the meds...TAKE THEM!! I was on dilaudid which was ok, but since I have such a high tolerance for pain meds it didnt work as well as I would have liked it to. My surgeon doesnt use demerol which is what works for me and I don't like morophine so I dealt with the pain more than I had planned. I got up and walked on Friday and the truth is that it HURT like HELL! But it helped. I was on only ice chips for the first 2 days, then a clear liquid (sips only) diet for the next 3 days then finally I was able to eat low fiber soft foods the 2 days before I went home. I didn't have a bowel movement until the morning I was being discharged and did not have an NG tube. Over all the surgery sucked, but it was SOO worth it considering now I have little to no pain at all. GOOD LUCK!!!

PS - If you have questions (even up until the time they give you the meds to knock you out) don't hesitate to ask!!! :)
Posted 1/10/2008 3:59 PM (GMT 0)
thanks for the reply...that's quite the story. I'm soo glad you are feeling better. I will ask today what meds they use post op. I noticed above that you had major flare up during pregnancy (can't imagine..being pregnant is hard enough). When I had both our boys, I never felt better CD wise...I could eat anything and gained lots of weight for once! Tried soo hard to keep the weight afterwards but slow the CD crept back and off came the weight. So amazing how everyone is so different. talk to you soon.
Posted 1/11/2008 3:44 AM (GMT 0)

smile1967 said...
Hi Robert! Thanks for your unfortunately very well educated experience advice. You sound like a pro. The surgeon did mention that he would be attempting to do the surgery by laparoscope, depending on what he actually finds when he goes in. He also said I would probably be in the hospital for about 3 days minimum. So I guess its wait and see. Mesalamine - I'm not familiar with that drug..is it an anti-inflammatory? Does it contain sulpha? (allergic) Thanks again!

Most people know mesalamine by one of its trade names: Pentasa; Rowasa; Asacol. Yes, it is an anti-inflammatory drug.

I know that sulfasalazine contains sulfa, but I don't think that mesalamine does. You'd need to confirm that first with a doctor first, of course. Here's some info:

http://www.medicinenet.com/mesalamine/article.htm

best regards,
Robert
Posted 1/11/2008 4:33 AM (GMT 0)
thanks Robert! Yes, it did find out that mesalamine is Pentasa, which is what I have been taking for almost 2 years. Just never heard of the generic version. No, it does not contain sulpha.
Posted 1/11/2008 2:33 PM (GMT 0)
bump

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