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Straight Talk About Colorectal Surgery

No two individuals will react the same way when they hear they must have surgery: everyone has his or her own coping strategies. Still, it may be reassuring to know that you can do a lot to ease any concerns you might have.

We asked Jennifer Kimberling, ARNP, ET, the Section's advanced registered nurse practitioner, to discuss the four most frequently asked questions patients have about colorectal surgery. Here are her responses, along with some tips to help you as you prepare for surgery.

Pain, Pain Go Away
Unfortunately, everyone will feel a certain amount of pain after surgery. Not surprisingly, pain tops the list of concerns for anyone who is undergoing surgery, according to Kimberling. Yet, your healthcare team can do quite a lot to make you more comfortable.

"Today, patients have a variety of options—including epidural analgesia and PCA (patient controlled analgesia) pumps—to achieve optimum pain relief," says Kimberling.

An "epidural" is the type of pain relief method commonly used for women who are in labor. A small tube is inserted into the back, and pain medication is delivered to this area.

On the other hand, you might prefer a PCA pump, which allows you to administer pain medicine at set intervals—i.e., every 10 minutes—through your intravenous line using a button that you press. Your doctor can adjust your dosage up or down, according to your needs.

No matter which option you choose, there is no reason for you to suffer needlessly in pain.

"Many patients make the mistake of waiting until they are in severe pain before telling their nurse that their pain medicine is ineffective. Please let us know right away so that we can adjust your medication," stresses Kimberling.

What You Can Do

  • Tell your anesthesiologist if you have ever had a bad reaction to any kind of anesthesia.
  • Inform both your physician and anesthesiologist if you have drug allergies or other allergies. For example, some people are allergic to penicillin. Also, be sure to mention any allergies to tape or latex.
  • Be sure to relate any bad reactions to certain medicines you have experienced in the past. For instance, some individuals cannot take the pain reliever codeine because it makes them nauseated.
  • Let your anesthesiologist and doctor know if you have been taking anti-anxiety medicines or pain medication regularly.

Know the Risks
"Patients want and need to know the potential risks involved with surgery. We try to be very sensitive to the needs of our patients and to anticipate their questions," says Kimberling.

Potential complications can vary depending on type of colorectal disease you have and the procedure being performed. Generally, for people who are otherwise healthy, infections are considered the most common potential risks. They may include:

  • wound infections,
  • urinary tract infections,
  • pneumonia, and
  • intra-abdominal infections if the area of surgery doesn't heal properly.

That's why everyone who is undergoing surgery is prescribed a combination of antibiotics and a preparation to cleanse the bowel prior to surgery. Additional antibiotics are administered intravenously during and after surgery.

Kimberling cautions that some patients, who take drugs that suppress their immune system, may be at greater risk of developing any one of the above potential complications. Such patients might also be at increased risk of delayed healing. Make sure that your surgeon knows if you are taking any immunosuppressive drugs—including prednisone—so that your healthcare team can keep a close watch for infections.

What You Can Do

  • Ask your surgeon what potential complications can occur with surgery and what are the more common complications.
  • Although blood is screened very carefully, there are still risks associated with blood transfusion and many people are concerned about receiving blood transfusions. Ask your surgeon if you can donate your own blood prior to surgery, if this has not been discussed.
  • You will be given a laxative preparation and antibiotic. Be sure to follow the instructions for both.
  • On the first day after surgery, your healthcare team will help you get up to walk. Pain medication may be given beforehand to make it more comfortable for you. Even if you can only take a few steps in the beginning, walking can help decrease the risk of pneumonia as well as other postoperative complications, such as formation of blood clots.

Home Sweet Home
"When can I go home?" is the most difficult question to answer. Provided there are no setbacks, your date of discharge from the hospital largely depends upon your return of bowel function. How soon bowel function returns after surgery varies among individuals, which is normal.

Kimberling explains that for some people, bowel function returns in 24 hours, while it might take several days for other individuals. Most folks wonder how they can have a bowel movement when they have not eaten in days. This is possible because you produce about a quart of digestive juices every day, whether you have eaten or not. The passage of this liquid waste is a sign that your bowel function has returned.

Once that has occurred, you can expect your diet to be gradually increased—beginning with clear liquids (i.e., chicken broth, Jell-O), then full liquids (i.e., ice cream, milk, cream soups), and finally bland foods. Tolerating this type of diet is your meal ticket home.

What You Can Do

  • Remember that walking speeds the return of bowel function. Get moving as soon as your doctor permits it.
  • Eat and drink only as much as you are able to tolerate, but do not force yourself.
  • Keep in mind that everybody recovers at his or her own pace.

Great Expectations
Most patients want to know what their expectations should be after surgery. This depends upon the operation being performed, your disease state, age, and overall health.

Be sure to give yourself time to mentally prepare for what you may experience postoperatively. For instance, you may have a sore throat because of a tube that helped you breathe during surgery. Lozenges can help soothe your throat. You might also have periods of depression while in the hospital or when you return home. This is normal. Share your feelings about the operation with your doctor and nurse.

"Please don't feel like you have to hold anything back. Express your concerns to us before and after surgery, that's what we're here to address," Kimberling says.

Also, realize that the body takes time to heal. Try not to compare yourself to others in similar situations because what applies to one person, may not apply to you.

What You Can Do

  • Don't be shy: there is no such thing as a "stupid question." If it's important to you, it's important to your doctor.
  • Read and discuss the postoperative instructions with your nurse. Ask questions if you are unsure about something or need further explanation.
  • Do not be afraid if you wake up with an intravenous (IV) line. It is there to provide fluids, medicines, and, in some cases, nutrients until you are well enough to take them by mouth.
  • Call your physician or nurse if you experience any problems after you get home.

When it comes to your medical needs, you are your own best advocate. Listen to your body and trust your intuition if you believe something is wrong. Enlist the aid and support of family, friends, and other qualified members of your healthcare team. Together, you can help to ensure the best surgical outcome.

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