tag:blogger.com,1999:blog-4968787219619380438.post3011540807060293436..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: What about activity restrictions after surgery? Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger26125tag:blogger.com,1999:blog-4968787219619380438.post-27450351269649030432020-02-17T10:41:00.277-05:002020-02-17T10:41:00.277-05:00Had apy in '74 as a girl - in a Denver hospita...Had apy in '74 as a girl - in a Denver hospital for 4 days. Coughing hurt like hell, but I was forced. And at some point, I was taken on walks.<br /><br />In November 2016, had two in one female surgeries. While I did get up and sometimes cooked or made coffee, I did stay in bed most the time for a week. The day after, I got up and missed a stair and darn near fell on my face, though.<br /><br />A chole done 3 weeks ago has not been going well. But I seem to overdo it. Day after wore pants to a condo candidate event - and was in terrible pain after. Hurt the rest of the week (but got up most every afternoon and sat at my home desk). That Saturday, noticed the belly button was infected and I was so bloated, the skin on my stomach was so tight, I felt I was going to explode! Still, that Saturday, went to an event - and my belly button stitch opened up and more pain. This Saturday (two days ago), went to store and had to lift a "heavy" (15-20#) bag into my car. Two hours leaning on the cart and wandering the store caused a lot of pain - bit ibuprofen was fine. Cooked breakfast and dinner (reaching up and lifting things most likely over 10#). Had to take the tylenol codeine after the 1 am ibuprofen didn't work and woke up in terrible pain (under breastbone) at 5. Supposed to go back into work (instead of working from home PT) Wednesday, but don't think I can STILL wear pants. Anyway, it feels like I should have probably stayed in bed for a few days, just getting up to walk a bit...Cyn Bhttps://www.blogger.com/profile/16747042212927773087noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-64114312223576105492016-06-10T07:19:29.639-04:002016-06-10T07:19:29.639-04:00Amazing post!
Thanks!
Amazing post! <br />Thanks!<br />GHnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-75915712643046180572016-01-27T22:20:09.240-05:002016-01-27T22:20:09.240-05:00Don, I laughed out loud at that one. Thanks. Don, I laughed out loud at that one. Thanks. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-65678501949257066152016-01-27T14:55:21.176-05:002016-01-27T14:55:21.176-05:00I was in the recovery room after a minor procedure...I was in the recovery room after a minor procedure when the guy in the next bed was asked by a nurse if he had urinated yet. He answered "No". The nurse looked concerned, until he went on: "the doctor told me to avoid heavy lifting" The whole room erupted in laughter.Donhttps://www.blogger.com/profile/16915390836558865110noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-50654207136377024152016-01-17T22:20:10.895-05:002016-01-17T22:20:10.895-05:00Bill, thanks for the reference. It is similar to t...Bill, thanks for the reference. It is similar to the one posted by anonymous on 1/4/16. Amazing that studies like this have received no mentions and have had no effect on the way postop patients are managed. Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-51641513925942191522016-01-17T09:46:42.351-05:002016-01-17T09:46:42.351-05:00A study following gynecologic surgery:
Methods: T...A study following gynecologic surgery:<br /><br />Methods: Thirty women of wide age and weight ranges who were not undergoing treatment for pelvic floor disorders performed 3 repetitions of various activities while intra-abdominal pressures (baseline and maximal) were approximated via microtip rectal catheters.<br /><br />RESULTS: Median peak abdominal pressures ranged from 48 (lifting 8 lb from a counter) to 150 (lifting 35 lb from the floor), with much variation. Many activities did not raise the intra-abdominal pressure more than simply getting out of a chair, including lifting 8, 13, and 20 lb from a counter, lifting 8 or 13 lb from the floor, climbing stairs, walking briskly, or doing abdominal crunches. Body mass index and abdominal circumference each correlated positively with peak, but not net, pressures. <br /><br />CONCLUSION: Some activities commonly restricted postoperatively have no greater effect on intra-abdominal pressures than unavoidable activities like rising from a chair. How lifting is done impacts intra-abdominal pressure. Many current postoperative guidelines are needlessly restrictive.<br /><br />Weir LF, et. al. Postoperative activity restrictions: any evidence? Obstet Gynecol. 2006;107:305-9.Bill Parkernoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-77035160758273646652016-01-10T11:43:28.719-05:002016-01-10T11:43:28.719-05:00Erik, great story. I had not heard about it before...Erik, great story. I had not heard about it before. Thanks.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-59672023739124605552016-01-10T11:26:27.119-05:002016-01-10T11:26:27.119-05:00« 40 days prior to the 1964 Summer Olympics in Tok...« 40 days prior to the 1964 Summer Olympics in Tokyo, during a training run near Addis Ababa, Abebe Bikila started to feel pain. Unaware of the cause of the pain, he attempted to overcome this pain but collapsed. He was taken to the hospital where he was diagnosed with acute appendicitis. He was operated on and shortly thereafter and even during his recovery period he started jogging in the hospital courtyard at night. »<br />https://en.wikipedia.org/wiki/Abebe_Bikila@erikneveshttps://www.blogger.com/profile/10197408856189037389noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-90704187130412998692016-01-07T17:32:01.411-05:002016-01-07T17:32:01.411-05:00Fit people tend to recover faster than those who a...Fit people tend to recover faster than those who aren't fit.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-63316931492435166232016-01-07T13:49:45.516-05:002016-01-07T13:49:45.516-05:00yes each person & surgery creates a new situat...yes each person & surgery creates a new situation. <br /><br />When I was a student nurse in 1986 I had a patient who I was suppose to give a shot of morphine the morning after her hernia operation. She was a jazzerize instructor & no kidding, I actually had to walk really fast to catch up to her on her "walk" down the hallway! Libbyhttps://www.blogger.com/profile/09274573439351833726noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-11267329718088421542016-01-06T07:05:08.704-05:002016-01-06T07:05:08.704-05:00Anon, thanks for the links to the story of Jeff Fa...Anon, thanks for the links to the story of Jeff Farrell. Don't forget, his operation was an open appendectomy with a medium to large incision. That's the way it was done back in the day.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9909590283830865932016-01-06T00:31:37.896-05:002016-01-06T00:31:37.896-05:00A case study supporting your point:
Jeff Farrell ...A case study supporting your point:<br /><br />Jeff Farrell qualified for the 1960 US Olympic Swimming Team - 6 days after an emergency appendectomy.<br /><br />https://news.google.com/newspapers?nid=1873&dat=19600803&id=HYoeAAAAIBAJ&sjid=gcwEAAAAIBAJ&pg=527,343451&hl=en<br /><br />I was a senior at Wichita High School East when this happened and graduated in 1961, four years after Jeff Farrell. Not a swimmer or even a varsity runner in cross country or track, I am forever grateful for my time with "Timmie" and believe Jeff Farrell's swimming training under Coach Timmons (Wichita Swim Club and 1 year at Wichita East)fueled his determination through his life ever after.<br /> <br />More about Jeff Farrell:<br /><br />http://www.kshof.org/inductees/2-kansas-sports-hall-of-fame/inductees/123-farrell-jeff.html<br /><br />http://www.ishof.org/jeff-farrell-%28usa%29.html<br /><br />And about "Timmie":<br /><br />http://www.legacy.com/obituaries/kansas/obituary.aspx?pid=175460563<br /><br />Identified by Robert Gates as " a particular person outside his family who had a lasting influence on him."<br /><br />http://cjonline.com/news/local/2010-01-29/gates_honored_as_kansan_of_yearAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-58716720175665069962016-01-05T13:11:26.360-05:002016-01-05T13:11:26.360-05:00Dear Skeptical Scalpel,
Thank you for the post! ...Dear Skeptical Scalpel,<br /><br />Thank you for the post! I learned something new today about Valsalva and inguinal hernias (just a hobbyist hoping to be an RN in a few years). Muchos Gracias!!!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-49588382276615213622016-01-05T07:41:03.479-05:002016-01-05T07:41:03.479-05:00Thanks for your input. Walking after hernia surger...Thanks for your input. Walking after hernia surgery may have started at the Shouldice Clinic in Canada. I visited there in 1980 and was impressed that postop patients were walking around. The rest of the world gradually adopted the policy.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25033215918829973952016-01-05T00:30:36.571-05:002016-01-05T00:30:36.571-05:00I am a physician, and I have three inguinal hernia...I am a physician, and I have three inguinal hernia repairs.<br />The first was over 30 years ago. I was in the hospital for a couple of days and severely activity restricted, and the first week after surgery was the worst of the three repairs.<br />Then that hernia recurred in 1990's and the instructions included early mobilization on the day of surgery, and increasing walking as tolerated starting on the day of surgery, and the first week of surgery was much more comfortable.<br />Then I had another hernia on the other side, where the surgeon wanted a fair amount of walking on the day of surgery and vigorous walking starting the day after surgery, and again the first week after surgery was much more comfortable than when no activity was recommended many years ago. <br />Facial skin cancer surgery instructions to prevent post operative bleeding may not be all that analagous to surgery of specialized areas (e.g., inguinal hernia) where immediate stretching of tissue may of significant benefit.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-62672404444464460832016-01-04T13:37:52.142-05:002016-01-04T13:37:52.142-05:00Ro, things changed in late 70s. No more drains or ...Ro, things changed in late 70s. No more drains or NG tubes in cholecystectomies. Breast biopsies went home same day, and much more. <br /><br />Olympic, you are correct. I hadn't thought about it before, but this is an area that needs a lot of improvement.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-9449167325948568822016-01-04T12:32:25.618-05:002016-01-04T12:32:25.618-05:00Great post. Thank you. Unfortunately, I have too m...Great post. Thank you. Unfortunately, I have too much experience as a surgical patient: 2 inguinal herniorrhaphies, Heller myotomy, multiple pneumatic dilations, and esophagectomy. To say that the post-surgical activity restrictions were inconsistent is an understatement. I am also a competitive weightlifter which you would think would factor into the recommendations - nope. How you lift (and even how your think about the lift), how you perform any activity, will completely change the forces imparted on the body. This is even true for coughing, sneezing, and any other valsalva maneuver. Learning how to breathe is the key. Is the surgeon ever involved in these recommendations? Yes, they will make recommendations, but have never been involved in my recovery process. Lucky for me, my specialty is physical rehabilitation, so I wrote my own recovery program (with the help of many others). I cannot tell you how important this is for OPTIMAL recovery. If this program is not discussed with the patient and written pre-surgery, the patient is already behind. I have treated so many patients for whom no guidance whatsoever was given and this is not only disappointing, but unacceptable. For the surgeons out there, if you are interested in learning how to significantly improve your outcomes, I would love to discuss. I have heard, “how come he/she never told me about that” too many times.Olympicdchttp://www.livingwithachalasia.orgnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-78107020589646439442016-01-04T10:26:21.169-05:002016-01-04T10:26:21.169-05:00Interesting article. I was a resident in the 80s,...Interesting article. I was a resident in the 80s, and there was no bedrest for hernia patients. I think your hospital may be have over conservative. I did scrub with a very old scrub nurse back then who was a nursing student back in the 1930s. She said hernia repair patients were at strict bedrest for a week, and her job was to spoon feed the patients, because it was feared lifting the head off the pillow to eat could rip the repair.....times certainly have changed. RoMghttps://www.blogger.com/profile/09876699002108002617noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-66774414388336754732016-01-04T09:50:25.652-05:002016-01-04T09:50:25.652-05:00Thanks for the quick response. I will get the full...Thanks for the quick response. I will get the full text and read it.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-88887457562960992052016-01-04T09:10:19.880-05:002016-01-04T09:10:19.880-05:00http://link.springer.com/article/10.1007/s00464-00...http://link.springer.com/article/10.1007/s00464-008-0080-0Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-66221442102121251592016-01-04T09:07:14.616-05:002016-01-04T09:07:14.616-05:00Anon, that is really interesting. Can you post a l...Anon, that is really interesting. Can you post a link to the study or cite it please?Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-55835384870229098662016-01-04T09:01:06.337-05:002016-01-04T09:01:06.337-05:00You should take a look at this study. They measur...You should take a look at this study. They measured intragastric and bladder pressures while people were coughing, retching and lifting weights. Coughing and retching increased pressure much more than lifting weights.<br /><br />The mean bladder pressure while bench pressing 114 lbs was 5 mm Hg, comprared to coughing 37 and vomiting 81. But I guess its a lot easier to tell a patient not to bench press 114 lbs for 4 weeks than it is to tell them not to cough for 4 weeks.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-59455439179853102362016-01-04T07:56:35.827-05:002016-01-04T07:56:35.827-05:00Daco, I agree that pain is a good barometer for li...Daco, I agree that pain is a good barometer for limiting activity.<br /><br />Amir, nice article. More activity is better.<br /><br />Anon, everyone recovers at a different pace and each operation is different too. One activity regimen does not fit everyone.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-39049081252677931622016-01-03T17:01:27.841-05:002016-01-03T17:01:27.841-05:00Alert Artiger, I gotta hear a comment on this.
I...Alert Artiger, I gotta hear a comment on this. <br /><br />I totally agree. I had my first abdominal surgery and it took 2 weeks just to do basic stuff. My second I was ready to go after a few days. My 3rd one (different surgery than the first 2), I was ready to go in 5-6 days. The 4th, simple lap choly, I couldn't really get a clue until a day or so after and my parents were afraid for me to leave the hospital until 48 hours after. Anesthesia issues. Once that resolved, I was ok to hit the saddle in a week, but restrained until two weeks and then the doctor said three. I asked him what he was smoking. :)Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-82608555366732608892016-01-03T16:50:18.266-05:002016-01-03T16:50:18.266-05:00Great posting!
We showed, in a rather limited pros...Great posting!<br />We showed, in a rather limited prospective randomized trial, that physical exercise<br />following cystectomy is of benefit for the patients.<br /><br />Please see link:<br />http://www.ncbi.nlm.nih.gov/pubmed/24249842<br />Best regards<br /><br />Amir Sherif<br />MD,PhD<br />Urology section<br />Umeå University Hospital<br />Sweden<br /><br />Anonymousnoreply@blogger.com