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Dealing with the pain of abdominal surgery

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Newsmaker
Patients have asked me if "...is it going to hurt?", or "… how much pain am I going to have?" before I perform a procedure. My answer has been that we have pain medication that controls the pain.
I was offered the following essay by a patient. I found it to be informative and interesting. Here is my disclaimer: He consented to the publication of his essay. Also It is not a medical article, but a subjective patient perspective. Yet, I
think it has valuable information. Thank you Dr. Bennett
Ara Keshishian, MD, FACS

DEALING WITH THE PAIN OF ABDOMINAL SURGERY
A Patient's Perspective

I'm not sure what it takes to become an expert in abdominal surgery. Yet after having the Duodenal Switch operation and three hernia repair surgeries in five
years, I have a pretty good perspective from a patient point of view.. In this article I'd like to talk about the four different kinds of pain I have experienced with each surgery and how to deal with it. Please remember that this is not a scientific description of pain, but rather my subjective perception of pain, and how I deal with it.

My first insight about pain is that I don't like it! I could never really understand why they wanted me to get up from the gurney and walk around the room. Don't they know how bad it hurts? I'll admit to the fact that I was surprised every time how much it hurts. The pain is amazing and surprising. Part of you wants to swoon to the ground until you realize that it would really hurt to get back up!

I've identified four kinds of pain common with my four abdominal surgeries:

1. Pain related to the IV's, cuts, tubes, and bruising from the actual surgery. While you're in the hospital you will experience short term pain related to needles (insulin injections for example), pain from theamazing pressure devices on your legs to keep you from getting blood clots, and other surprises in the night. The abdomen is apparently the center muscle of every meaningful activity from walking, getting up and down, eating, laughing, coughing (have a bottle of Vicks Cough Syrup on hand), talking, and the eventual move into or out of bed. You will experience a sore throat from the tubes placed in your throat. You will experience soreness from the catheter into your bladder. You'll notice tenderness in the areas around the drainage tubes. You'll certainly experience the thrill of eighteen inches of tubing being pulled from deep within your body a week after surgery- but only momentarily. You'll find that any movement is painful for the first week. After that it'll surprise you from time to time when you've gone past your new limits.
2. Pain related to GAS. I'm not sure there is much discussion of this problem but it can e very distressing. It really hurts. I had to spend an extra day or so after my first surgery because the pain from gas was way off the chart. I walked and walked the halls of the hospital hoping for relief. I couldn't understand how the gas moved from within my body cavity but wouldn't exit! I could only wish that I could put a tube into my body and transfer the gas into a methane factory for use in my car!
3. Pain related to Constipation. Due to the effects of the narcotic medications you received in the hospital you'll not have a meaningful bowel movement for three to six days. All this time your body is gradually building a softball sized stool. You'll discover that your body is really not made for this kind of birthing process! You'll also discover that going to the bathroom is also centered in the abdomen. Lowering yourself to the toilet is painful. Pushing to deliver the soft ball sized stool is painful. You are faced with conflicting pains. Do you face the pain of using your abdominal muscles to push the dreaded stool out or endure the pain of constipation? Eventually the moment of truth will arise and you'll have no choice but to push the little critter out. After delivery you really hope you're not having twins.
4. Pain related to reoccurring? back and body pain. Almost every adult I know takes pain relievers on a regular basis for a bad back or for some kind of reoccurring pain. Due to the pain you experience from the surgical pains, you are unable to sleep in the same position you did prior to your surgery. I suspect that we all choose our sleeping position to eliminate night time pain. For few weeks after your surgery I found myself sleeping in a chair, on the living room couch etc. Whatever existing pain you're dealing with will be accentuated. Perhaps another reason for this is because you've been asked to get off any painkillers that thin your blood. By the time of your surgery you may already be experiencing additional pain

How do we face pain?

1. PAIN MEDICATION: Take your pain meds. Take them so you can be s
   comfortable as possible, and this will in turn make you be more active and heal faster. You body needs the break from the tension and trauma of the surgery. Don't listen to the "energizer bunny rabbits" out there that go from surgery to shopping in Cambria in less than four days.
2. TALK ABOUT IT: Talk about it to the people around you. They'll not have any idea how to help but you need to talk about it so you don't feel so alone.
3. DEALING WITH PAIN AT NIGHT: Find some alternative things to do at night… You'll discover that after everyone has gone to bed you are uniquely alone in your pain. You may find yourself experiencing all four types of pain at the same time during the first ten days. I find that laying in bed or sitting in my chair doesn't help much. I get up and walk. I suspect that listening to a book on tape would be a good way to get my mind off my pain.
4. PRAY-MEDITATE- RELAX. I'm a person of faith and prayer as I've noticed lots of my fellow bariatric co-patients are. Mediate and relax both mentally and physically. Your body will heal faster it is in its own comfort zone.
5. BE INFORMED: Talk to Dr. K prior to your surgery about how to deal
   with all four types of pain. You'll find he has a unique "medical" perspective on pain. Refer to your notebook. If you have a chiropractor I'd suggest you get treatments after your surgeon to do so has cleared you.
6. FOCUS: In the case of your original weight loss surgery the outcome is a great thing to focus on. You'll lose a great deal of weight. You'll start new things and new adventures. You'll buy lots of new clothes. In the case of hernia repairs I tried to focus on feeling better and on future golf games free from a bulging little friend hanging over my belt when I putted.
7. BE NICE TO YOUR CAREGIVERS: Try not to be cranky with your care givers. It was your choice to have surgery. Don't blame them. You're dependent upon them for almost everything for the first ten days so be nice to them.
8. PLAN TO HELP OTHERS: Help those that suffer after you. You are one of the few people who really know what it's like to experience abdominal surgery. You know the pain will soon go away and you'll forget what it really felt like. How do the Doctor's do that? Is there really a shot to help you forget what it feels like?
9. TRANSITION AWAY FROM NARCOTICS IN ABOUT ONE WEEK:
   Dealing with the transition from oral narcotic pain medication to over the counter pain killers is quite challenging. Why ever get off it if you can keep from hurting? They slow down your body's elimination system that leads to some of the Constipation and Gas pain we experience. It is to our advantage that we get off the narcotics as soon as possible. The sixth or seventh day seemed to work for me. I hope that this article will help other patients understand the pain you will face and how to deal with it. P.S. I wouldn't categorize wearing the binder as falling under the category of pain, but it is definitely irritating!

A little about myself: Dr. Randy L. Bennett
I am the Director of Missions of the Kern County Southern Baptist Association. I have been a Southern Baptist preacher since my teens in Southern California. I have lived in Bakersfield with my wife Carol and daughter Carolyn I have become an avid golfer since having Weight Loss Surgery. Prior to the surgery I was able to golf only once a week at the most. I been able to play four times in a week three different times and was ready for day five. Since having Weight Loss Surgery my average score dropped from the low nineties to the low eighties. I had my first hole in one, first eagle, and have broken eighty three times in the last two years. I have become an advocate for Weight Loss Surgery encouraging a number of co-workers to have the surgery. One co-worker was using a walker to get around. He had Weight Loss Surgery three years ago and is now playing golf at least two times a week

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