The first Twelve Weeks After Surgery
The first thing you notice is that you hurt a bit more at home than you did in the hospital. In the hospital you had a nurse and host of other people to take care of your needs. Perhaps you didn’t like the way they took care of you, but you didn’t have to worry about much of anything but getting up and doing laps around the nurse’s station. At home it is a different matter, especially if you have kids (and that includes a husband who, after all, is just a larger version of a child).
Sleep After Weight Loss Surgery
—No, you don’t need a pill
Sleep disturbances after any major surgery are common. In fact sleeping in general is a difficult problem. Remember the nurses waking you up to take blood pressure, check on your pulse, and in general ask you a few questions? Remember your roommate, or the fellow across the hall that loved to yell out for Aunt Mabel? When sleep cycles become disturbed, it is difficult to get them back. Do not fret, your only goal during this period of time is to keep fluids in and walk. Sleeping pills are not the answer, and may be a problem, and pain medication taken in order to sleep is definitely not the answer.
Sleeping pills are highly addictive, and the quality of sleep is not that good. Some studies have shown that you become dependent on the pills for sleep in a very short period of time, so my policy has been to never prescribe them.
Some patients use the narcotic to help them sleep but that has the same effect: the sleep you get will be poor, and the ability to sleep without the pills is more difficult.
If you are going to be up in the night what should you do? If you want to be sleeping then you shouldn’t reward yourself by watching television, hanging out in internet chat rooms, or reading a good book. Instead, follow the Christian Harris plan: if you have not fallen asleep in 45 minutes then get up and do something you do not like to do. For example, if you hate washing the dishes, then wash them or clean up something, scrub the kitchen floor, whatever. Do that for 45 minutes and go back to bed. If you are not asleep still then repeat what you did—yes, that means, re-wash the dishes. Again–45 minutes. You don’t get the feeling you have accomplished anything, and it isn’t fun. Eventually your body will get the joke, and simply sleep. If in several weeks you have another bout with insomnia, get up and wash the dishes.
I gave the Harris prescription to a very nice young housewife, who immediately started to laugh at me. She said, "You really don’t know me, do you, Dr. Simpson?" I told her that I didn’t understand, and she said the thing she enjoyed the most was cleaning, putting things in order, categorizing, and would happily spend the entire evening rewashing dishes. I didn’t want to give her the diagnosis of obsessive-compulsive-disorder (OCD) since she had already given it to herself. My next immediate thought was to hire her to do the filing in my office, she could have the night shift. She did find a task she didn’t like doing, and before long was enjoying a restful nights sleep—her task that got her to sleep was to read her daughter’s homework in history.
The other way to break a simple cycle, of staying up too late, isn’t something you can do right after surgery—to pull and all-nighter and go to bed the following evening at a reasonable hour.
Getting into and out of bed
—Other places to sleep
Getting in and out of bed can be a major challenge. It isn’t fun, it isn’t easy, and the more pain you feel in your incision, the harder it is. For most patients we recommend you obtain a recliner to sleep in the first few nights. It is easier to get in and out of them, and they can be quite comfortable. Some recliners take a lot of work to get in and out of, so if you are in the market for one, make certain the one you purchase glides easily. There are even recliners that have the electronic helper to get you out of them—I always imagine these devices going crazy and launching a patient into orbit.
Be sure and have some favorite items on the nightstand—a sports bottle with water, a telephone (lighted) and easy access to the bathroom. Some patients like keeping their pain medicine by their nightstand, and if you feel you need this that is fine, but if you do I recommend only keeping one dose by your nightstand. Why, you ask—because that way you don’t have to worry about overdosing yourself. If your spouse puts a lot of pain medicine by the nightstand—be very worried.
Oh, if you need to get up and go to the bathroom, get up and go. Don’t have a urinal there; especially don’t keep it by the sports bottle! You need to walk, so think about getting up and walking.
Other patients purchase pillow wedges so they have some elevation by their bed. Still others make these wedges with lots of pillows surrounding them (reminds me of a cocoon). Having a hospital bed can help the first couple of days, but very few patients get these, and they are rarely needed. I often wished I had one so I could sit up and watch my favorite television program at night. We do like patients to sleep at a fifteen degree upright angle, and for some the only way is to have the head of your bed propped up a bit—one of those little chores you should do before you go to the hospital.
Feeling tired and needing naps
Surgery is tough. You will need naps, and you will be very tired if you return to work after three weeks. There is nothing wrong with you, you had major surgery, and major surgery takes a lot out of you. Expect that it will be three months before you feel normal.
Taking naps is normal after major surgery; so if you feel like it, don’t deny yourself. You need to follow a few simple rules about naptime, however. First, if you are going to take a nap, then take a nap. Don’t sit in your recliner watching re-runs and drift in and out of sleep. Do like President Harry Truman did, undress, go to bed, turn out the light, and take a proper nap. Don’t take a long nap either—twenty minutes to an hour is all that you will need, not a two or four hour rest. If you take longer naps, you will also make it difficult to rest throughout the night.
Those who have had laparoscopy have the same metabolic effects of surgery, the change in your own body metabolism, are all unrelated to whether the surgery was done "open" or laparoscopically. So, plan on three months where you will feel a bit tired, and while it will get better, it gets better on a week-to-week basis, not day to day. So you will notice that this week you feel a bit better than last week. Monday’s however, especially when you go back to work, still feel like Mondays, no matter how much weight you lose, and Fridays, well, they are still a great day.
Ability to Concentrate
—or why do I not want to do math problems?
The ability to concentrate on even simple things following surgery is impaired. This is one of the reasons we ask you to have affairs in order prior to surgery, because after surgery it is sometimes difficult to concentrate. This became clear to me after having some knee surgery a number of years ago. I remember going home and instead of reading the newspaper, one of my favorite activities, all I could do was look at the pictures. I knew my ability to concentrate was not very good when some politicians actually made sense to me.
This is a temporary condition: you are not becoming senile; it is simply another effect of surgery. The best way to overcome this is to do plenty of walking, keep drinking water, and if you find that my book becomes more funny after surgery—then you are the exception and your ability to reason has improved.