Surgery and RH

[Kirstyr]

Does anyone have any insights or experience about surgery and RH?

I’ve been added to the waiting list for a relatively major gynae operation. I mentioned my RH at preassessment and the nurse said they may want me to stay in overnight (apparently my surgeon thought there was a chance of doing the procedure keyhole and as daycase.... but it’s likely to be converted to open, which would mean not daycase anyway)

My concern was more over fluid management, and if they use sugar containing fluids could I react to those once they stop them? Just trying to be aware of possible issues so I can manage them when I come round (or discuss with the anaesthetist before the operation!)

Any other issues I should be aware of? I work in the hospital so I think I can manage the menu carbs and get hugher protein options... but I imagine recovery will try and feed me dreaded toast....

 

[Brunneria]

These are very good questions, but I am afraid I don’t know the answers. I’m guessing that each hospital will have slightly different ways of doing things - and probably each department within that hospital.

I’ve had several general anaesthetics (dental work in my youth) but nothing since.
I was knocked sideways by the wisdom tooth op. V slow recovery, bad reaction to the anaesthetic. But that was 35 years ago, so my experience is far from current!

However, knowing my body as well as I do, i know how I would handle things - assuming that I had the liberty to make these decisions...

I would attempt to prep for the op by making sure I was in ketosis, running on ketones, and my glycogen stores were run down. That would be very low carb or fasting in the days leading up to the op.
This would minimise the way my stress hormones and liver would play silly ******* with my blood glucose.

I would be making strong protests if they wanted to give me glucose, and I would request NOT to be given it frequently, and ask for my request to be written in my notes. Obviously, discussing the liklihood of it during the pre-op.

And I would be asking my poor long suffering, but incredibly kind, husband to bring in food parcels (if I was stuck in overnight). Cold meat, salad bags, nuts, double cream, peanut butter (and a spoon). Actually cold meat and cheese would probably be enough for a one night stay.

If they wanted me to ‘eat something before you can go home’ then I would be pulling something like a kind bar, or a peanut 9bar out of my bag, and swerving the NHS tea, biccie and sandwich option. There would be several of them in my bag to cover any delays in discharge.

For myself, I have two problems. The first is that I sorted my own blood glucose control (and RH) without an official diagnosis. So what are the odds of hospital staff taking any notice of me hopping up and down saying ‘I’ve got RH’ if it isn’t recorded in my hospital or doctor’s notes? I do have a medicalert bracelet saying ‘reactive hypoglycaemic, do NOT treat hypos with glucose’. I also have plenty of blood glucose records to show RH hypers and hypos. But who would take any notice to that?

Oh, and I am very sensitive to caffeine. It sends my blood pressure high, and my blood glucose wangy. Some anaesthetics have caffeine in them. So I would be asking the anaesthetist to be aware of this, and hopefully discuss options...

Obviously, a lot of that may be completely irrelevant to you, but i hope some of it helps.

I hope your procedure goes well!

 

[DCUKMod]

Does anyone have any insights or experience about surgery and RH?

I’ve been added to the waiting list for a relatively major gynae operation. I mentioned my RH at preassessment and the nurse said they may want me to stay in overnight (apparently my surgeon thought there was a chance of doing the procedure keyhole and as daycase.... but it’s likely to be converted to open, which would mean not daycase anyway)

My concern was more over fluid management, and if they use sugar containing fluids could I react to those once they stop them? Just trying to be aware of possible issues so I can manage them when I come round (or discuss with the anaesthetist before the operation!)

Any other issues I should be aware of? I work in the hospital so I think I can manage the menu carbs and get hugher protein options... but I imagine recovery will try and feed me dreaded toast....

Kirsty - When your name comes to the top of the list and you have a date for your op, you will be called for a pre-op assessment appointment. At that appointment, they'll go through your medical history and what you are expecting in your op (history to ensure they have taken note of everything and that nothing has cropped up in themeantime), they'll weigh and measure you and do a raft of bloods, ECG etc. That is the perfect time to ensure your RH is noted and noted clearly on your records.

Before your op - you will see the anaesthetist to do your consent. As well as sending you off to sleep he'll be maintaining your fluids. He's the main man to ensure he knows what gives with you.

You will also see him again in the theatre anteroom.

So, you have lots of opportunities to ensure those who matter know about your RH.

Like Brunneria, I'd be getting my bloods into great shape before my op for the greatest chance of good, quick healing and recovery.

Good luck with your op. Do you know how long the waiting list is?

 

[Kirstyr]

Thank you both.

I’ve already had preassessment and the RH is clearly documented in thebit where she asked about diabetes and then she asked about the libre I was wearing at the time. I then pointed her towards the endocrinology section of my medical notes for further details (although the doctors there haven’t made a lot of progress with treatment and still want to do more tests). The nurse couldn’t say anything about if I would be on glucose/dextrose during the op.

Waiting list - unknown precisely. Consultant has requested he wants it done within 8 weeks and I’ve said it’s ok to take a cancellation, so it could be any time really. Waiting for the co ordinator to contact me with the precise date.

I will sort my bloods out as much as I can first... only obstacle is a repeat prolonged Ogtt in 2 weeks, but otherwise I will head back towards ketosis... fasting on and off is one of the few things I’ve found that makes my bloods play nicely. only thing is I’m still struggling with exercise induced hypos, the ketogenic diet isn’t working for some reason on these, although fasting does ironically, but I can’t exercise as much when fasted... trying to get the right timing and type of snack and meal pre/post. Sometimes it works, and sometimes I head into the low 3s or even 2s and I’m not even that active, just a 15 minute treadmill walk and 15 minute program on the bike.. I’m trying to be in the best shape so I heal faster after this op, in theory...

Hopefully I will be able to wear the libre during the op... so when I come round I may have chance to see what damage they did.

I intend on explaining in great deal to the anaesthetist about my weird reactions. And definitely will pack lots of protein snacks, and get hubby to top up with something from m&s on site.

 

[Lamont D]

As well as the great information above, always ask about the non sugar meds, or non sugar version of items used in surgery, including any anti biotic after, if infection is mentioned.

I think that I have mentioned before about excessive exercise, being a problem for me, I can do so much before causing a liver dump, I try avoid these as much as possible, walking is great for exercise and keeping blood sugar levels in check.
Also, if you are in normal levels, your body will cope better and heal quicker, that is my experience., I have had raised couple of small ops since going low carb!

Best wishes

 

[Marie 2]

I’m not sure about the UK but in the US there is a huge difference on how they handle diabetics in each hospital. Some have special teams in place and some hardly seem to do anything. Plus there is not a magic answer for each person and what their body will do.

Make sure you talk to the anesthesiologist before surgery with regards to care. Some anesthesiologist put a small amount of steroid into the mix and that can shoot up blood glucise levels too. But if you talk to them right at surgery time you can make sure your desires and concerns are being told to the actual person in charge of care.