Suggestions for Coping after major surgery: meds, etc
August 23, 2016 1:33 AM   Subscribe

I'll be having major surgery next month. The doctors say I will be on opioid painkillers for 2-4 weeks. I'm worried they will give me digestive problems, as I have a sensitive stomach. My other issue is staying in shape while recovering. It has taken me a year to get to my current fitness level. Doctor says no workouts besides walking and physical therapy for 1-2 months. I'm very concerned I will lose the muscle I have worked hard for, and gain fat. Any advice on either issue?
posted by CancerSucks to Health & Fitness (13 answers total) 3 users marked this as a favorite
 
I've had a pair of major GI-related surgeries over the last six years, so here's my experience from those two bouts of post-surgery recovery:

1) The opioids slow down the gut and cause constipation. Other than taking the pain away, that's about it. I was prescribed a laxative to offset the constipation, but I wasn't actually able to really "go" until I stopped taking the painkillers.

2) I lost about 20-30 pounds in the month after each surgery, because I was on either BRAT or liquid, low-calorie diets, which caused me to drop a lot of weight quickly. If you want to keep lean body mass, ask your doctor to talk to an on-staff nutritionist before your surgery, if you have not already been assigned one. They should have recommendations for high-protein, low-calorie foods you can eat during recovery.

Good luck.
posted by a lungful of dragon at 2:06 AM on August 23, 2016 [2 favorites]


Hi – a lot depends on which painkiller they give you, and your own particularities. A lot of people are fine on Tramadol, for instance; a few others have significant (not huge, but significant) issues with it. I'm among those who Did Not Do Well On Tramadol. As for morphine after general anesthesia, my stomach hates the stuff; I throw up if a butterfly flaps its wings. My GP switched me to an opium (yes, straight opium) + caffeine + paracetamol painkiller that was a whole lot better; basically no side effects. I only got loopy the first few days I took it. This was following surgery to reset a broken arm and put in three pins, btw. I had to have a second surgery to remove the pins where I told them no morphine, no Tramadol, I don't effing care if it hurts, and it was soooooo much better. More pain, yes, but there's a certain point where the painkillers make things worse and you'd rather just grit your teeth with the comfort of knowing you're not going to throw up for the next 24 hours. Anesthesia will still give you a wonky stomach, but I found it much more bearable without additional morphine.

If by chance you're going to have surgery around your stomach area, yeah, definitely beware morphine and discuss other options with your doctors. Throwing up on an empty stomach is a well-known side effect of morphine, all the more so for those of us who are sensitive. No fun at all when you just want to eat something once you finally can. Especially not fun when you've been operated on your gut (I had a laparoscopy for endometriosis several years ago and the day following surgery is still seared into my memory).
posted by fraula at 2:09 AM on August 23, 2016


Also re: muscle. For two months you may get a tiny bit fluffy, but no worries, you'll get back into the swing of things once you're ready for it. For instance, my right arm (the one I broke) was of course useless for 3 months, and to be sure I didn't accidentally reinjure it I didn't do any sports for that amount of time. Got a bit fluffy – I was eating a lot of cheese for calcium – but things got back to normal pretty quickly once I started working out again.
posted by fraula at 2:13 AM on August 23, 2016 [1 favorite]


Oh, yeah. I was prescribed anti-nausea meds (ondansetron/Zofran), but I never seemed to need them. I think it was because the painkillers I was taking at home were nothing nearly as strong as what I was given in the hospital. When I was hooked up to an IV, they administered morphine and fentanyl in doses large enough that they added intravenous Zofran. But once I was at home, I never seemed to feel sick in any real way. Still, if you're feeling sick in the recovery room, post-surgery, they may prescribe you anti-nausea meds for use when you're recovering at home.
posted by a lungful of dragon at 2:20 AM on August 23, 2016 [2 favorites]


You won't be discharged from the hospital until you are tolerating a regimen of oral painkillers, so don't worry too much about this -- it is very explicitly part of your surgeon's job to make sure you have adequate pain relief that doesn't cause unmanageable side effects. Do consider asking about adding or transitioning to a Tylenol regimen. I've had a few major surgeries over the years and was transitioned to standing Tylenol (325 mg every four hours round the clock) instead of oral opioids and that worked really well for me. Obviously, please be careful about adding Tylenol yourself because many painkillers contain Tylenol already.

In terms of maintaining lean muscle, the most important factors are to consume adequate calories and adequate grams of protein. In the post-operative period and for several weeks thereafter you might not have much appetite -- eat anyway. When I was recovering from surgery I lost my otherwise ravenous appetite for meat but was still able to hit my protein targets with lots of Greek yogurt, cottage cheese, and eggs. Because you will be healing from surgery and you will be relatively inactive, you'll want to consume about 1.5-2 g protein per kg of bodyweight (unless you are significantly overweight, in which case you can substitute so-called "ideal bodyweight" into that equation).

You will probably lose a little muscle, maybe gain a little fat, but getting back to where you were previously will take less time than you think if you allow yourself to heal fully and well from the surgery. In my experience (and, to be clear, I have no idea what your health situation is or what your surgery is), I had three major surgeries in one year and needed to take about a year off from working out with any seriousness. When I did start working out again, it was only about six months before I was stronger than I had ever been before. I don't know the physiological science behind it (something something muscle cells) but my understanding is that that's not uncommon.
posted by telegraph at 5:13 AM on August 23, 2016 [5 favorites]


I found the Norco (10/325 hydrocodone/acetaminophen) to be nicely pain relieving on it own, but I found I couldn't use it for abdominal surgery, as the resulting constipation (specifically: straining to poop) caused way more pain in the incision than was being alleviated. Crunchy suggestions to alleviate the constipation like flax seed and such were totally ineffective. Tylenol on its own was better.
posted by fingersandtoes at 9:25 AM on August 23, 2016


I'm just getting over a fractured rib from a bike crash and I found two things: an enthusiastic "yes" for laxatives, and that Norco was effective only at making me loopy without affecting the pain at all. The Motrin 600s were much better.

As for your gainz, I would focus on diet primarily. There's just no exercising when common movements pull or push muscles at the area where the pain is coming from. Over the past month I have gained a serious appreciation for the interconnectedness of my musculature.
posted by rhizome at 11:20 AM on August 23, 2016


So as to avoiding constipation post surgery - stool softener, laxative, drink a ton of water, eat prunes. Even doing all that I still end up stopping narcotic pain meds at some point because the gut stuff just outweighs the other pain relief. As others have said, your muscles will come back - more quickly than you might guess once you're cleared to work out again. Don't eat a lot of junk while you're unable to work out. And good luck healing!
posted by leslies at 12:12 PM on August 23, 2016


Google 'opioid/opiate bowel management/protocol' and similar things -- this stuff is pretty well known, though not all doctors are up to date on little things like: it's easier to deal stopping it before it starts; a stool softener alone is not enough (try adding senna); people who think they have good advice because they had a little episode of non-opiate-induced constipation are not worth listening to. Fibre can be a helpful add-in with softeners and laxatives but you must be interested in drinking a LOT of fluids with it, which you may or may not be. If you are at all constipating because you had a doctor with one-size-fits-all beliefs, take more laxatives instead of trying to tough it out (har har, sorry, no puns intended).

I am on morphine and don't throw up. I find I can eat a lot more just before bed than I can all day, which is socially awkward but otherwise fine.

Going into a major medical procedure in good physical shape is terrific; I would try not to think of it in terms of "losing gains" but just sheer delight over having made those gains in time for when they are most needed.
posted by kmennie at 3:08 PM on August 23, 2016


I am not your doctor and do not know details of your surgery, but I have known several people who had major surgeries and were comfortably managing pain with Tylenol after a week. This may be possible for you as well.

There's much good advice upthread already about managing constipation and nausea, so I won't duplicate it here.

I can't speak to how quickly you'll lose muscle or add it back, but in terms of gaining fat, don't forget how many calories the body expends to knit itself back together after physical trauma. During your initial recovery, it's possible you'll find yourself struggling to keep weight on after your appetite has returned (and even if it returns with a vengeance).

Also, don't underestimate the workout you're likely to get from physical therapy! A good physical therapy regimen often contains some degree of strength training, even if it doesn't target the muscles you're used to targeting.
posted by Owlcat at 6:41 PM on August 23, 2016


My only advice to add to the helpful information above is to try not to sweat exactly which drugs you're being given. If you've had a narcotic medication before and did well with it (or not so well), then definitely mention that, but if you've never personally had narcotics before and you start asking for fentanyl rather than morphine or Norco rather than oxycodone, or whatever - your doctors are really going to give you the side eye. None of these medications is going to be guaranteed not to give you GI issues - they all can cause nausea and constipation, and most any other information about what their effects will be is just anecdote and as such doesn't necessarily apply to you. You may be on narcotics for 2-4 weeks, yes, (or longer!) but many people do get off them within days of abdominal surgery, so that isn't set in stone.

Also a definite yes to stool softener before you need it, rather than after. Although it's true that you aren't supposed to be discharged before you are 'tolerating' a pain control regimen, I've seen it happen many times that people don't anticipate the level of constipation and it catches up with them after discharge because they did not take the stool softeners/laxatives. They then wonder why the abdominal pain which had been getting better as they recovered from surgery is now getting worse again....
posted by treehorn+bunny at 10:35 PM on August 23, 2016 [1 favorite]


Response by poster: Thanks everyone, I appreciate it!
posted by CancerSucks at 12:51 AM on August 24, 2016


I agree with treehorn+bunny that trying to micromanage your painkiller situation is going to seem odd. Side effects with opioid painkillers are pretty ymmv; taking Colace (a stool softener) and eating fruits and vegetables has been basically fine for me in the past. My best advice is to be vocal about side effects: itchiness, nausea, constipation, etc. They have medications to help solve those problems. I'm not sure if this is common practice, but I had my surgeons' cell numbers, so I could call or text them with questions/issues.

Cancer surgery was my first introduction to anti-anxiety medication. I took it both before the surgery and after. Cancer is hard and scary, and it's okay to take medication to help deal with those sorts of overwhelming feelings. Talk to your surgeon.

As far as fitness: I was out of the gym for six weeks. I didn't lose as much strength as I thought I would, and my running distance came back pretty quickly. I did walk a lot after surgery; don't discount it as a way to maintain fitness. (Turned out I had to do chemo after surgery, though; chemo was not good for my fitness. I'm still trying to claw my way back.)

I'm sorry you're dealing with cancer surgery. Agree with others that it's hard to tell what kind of advice to give you because we don't know what kind of surgery you're having. I had a unilateral mastectomy with DIEP flap reconstruction last year, meaning they reconstructed my breast using fat and blood vessels from my lower abdomen. I was in the hospital for five days and on opioids for about three weeks. If you'd like to talk, feel free to MeMail me.
posted by purpleclover at 10:52 AM on August 24, 2016


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