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Managed Healthcare Executive – Health Management
Tag Archives: Expect
What to expect after your surgery
So, you’ve been told you need to have an ileostomy formed and the big day arrives for you to go down to theatre and have it formed. All the questions you were going to ask have flown through your ears and back out. You sit there sign the forms and get prepared for theatre and either walked down or wheeled down depending on a planned or emergency surgery.
What is an ileostomy?
An ileostomy is where your small bowel is pulled out through an opening in your tummy and stitched into place and that will have a stoma bag attached to it and that is now how your faecal matter will be exiting your body rather than its usual route.
DISCLAIMER
“I am not a medical professional this is purely based from personal experience and several surgeries”
What happens after surgery?
You will awaken from your surgery in the recovery room and advised your stoma formation was successful and the surgery went well.
You will also be rather hazy and on the drug train that will help with the initial after surgery pain. Honestly it is going to hurt, I can’t lie about that. It will be painful, but the pain medication will take off the edge.
The following day
You have awoken to a new day and you are more lucid and the nurse will want to have you up and out of bed. The nurse is normally an enhanced recovery nurse and studies now show the quicker you are up and about then the quicker you will heal and get home (sounds sadistic) but it is a proven method and cuts discharge times for patients going home and recovering more quickly.
The aim on day one is to get you out of the bed and sitting up in a chair for at least half an hour and then back to bed.
Pain medication
Most patients have one of two options for pain relief. One is an epidural or the other is self-administered pump to top up should you be in any pain. I personally stay away from the epidural and it’s a longer recovery time and it normally numbs your abdomen and legs, so walking isn’t normally an option until it is removed. But please make your own choice depending on your pain tolerance. I prefer the pain relief pump and I am normally off of all Iv pain medication within 48 hrs and back to oral medication.
Ng Tubes
Now not everyone will wake up with one of these delightful tubes, but should your bowel be inactive and frozen then this is in until you start having normal bowel sounds and your bowel is active. If you do wake with one of these then it will be nil by mouth until normal action resumes and they will have other options of getting fluids and nutrition into your body. The Ng tube will be used to pull out any fluid collection’s and gas build up via a syringe they attach to an outlet on the tube.
Walk the line
Most gastro wards have a lovely yellow or red line that goes around the outer hub of the ward in a rectangle. The aim before discharge is to have you be able to walk that without getting breathless and experiencing pain. I have walked this many time with bits attached to me as I find I recover better at home and want to get out of the hospital.
Catheters
You will have a catheter inserted when you are under anaesthetic and this will remain in place to catch your urine and measure the output until you are mobile and able to get to the toilet to pass urine as normal. Don’t be alarmed at this, you won’t feel it unless you catch the tube when moving on the bed.
Drains
You will wake up and have one or maybe two drains attached to you that have the tube stitched into your abdomen with a bottle or drainage pack attached to the bottom. This is purely to drain any fluid or excess blood from your abdomen caused by the initial surgery. Sometimes these are removed quickly or on the day of discharge as long as the drain isn’t draining. My advice for when having these removed is to have oral pain relief half hour prior to removal. The pain is a weird one having these removed, it’s like a pressure and then a pop and it’s all over and removed. The site is dressed and left to heal on its own.
All expelled bodily functions are monitored
So, you are thinking yes, the catheter has gone and that’s a step forward to going home “It’s a brilliant step”. However once removed you will still have to pee in a pot until they are happy with the tests run on that and your output is in conjunction with what you are taking in with fluids. No, you can’t cheat. This is essential and needs to be monitored to make sure it is deemed safe for you to be sent home.
Ileostomy output
Your ileostomy output Is monitored until the day of discharge. They will not discharge you until your output has reached a porridge like consistency and the output is in line with what you are in-taking. There is food to help with this and that will be on a following post.
First bag change
If this is your first stoma then apologies as this will be daunting for you. General consensus from my experience is that if you can’t change your bag then discharge won’t be possible until you have a handle on the change. The stoma nurse will sit with you and show you how to change the appliance. Should you not feel comfortable with changing it then they will do that for you. The stoma will not be hurt by you changing it. It has no feeling. It may take several attempts but once you have mastered changing it yourself then that will be a weight off of your mind.
Stitch removal
It is normal to have the stitches removed from around the ileostomy site prior to discharge. This does not hurt and it’s better to have them removed as healing tissue can make them pull tight and cause discomfort. Please make sure you speak to your stoma nurse about this as some issues with leaking stomas and sore sites post-op are related to stitches not being removed and healthy tissue growing over the stitches.
Clothing
Track suit bottoms, leggings or good old-fashioned pyjamas will be your friend as they are light and don’t impact the surgery sites and rub on healing wounds.
Warfarin injections
Due to the surgery and risk of blood clots due to bed rest then these are injected once a day to thin your blood and prevent the risk of blood clots. You will also have to wear teddy stockings both for your entire hospital stay and for a month after discharge at home. They will also send you home with a 4-week supply of these to inject daily with a waste disposal for the needles.
Discharge
For you to be discharged you have to have a collective all clear from your consultant, surgeon and stoma nurse. Your stoma nurse has the final say and you won’t be discharged until she agrees that you are ok with your stoma and with its output and you are eating well.
I am hoping you found this informative and not to daunting.
Many Thanks
Louise aka CrohnsFighting Xx
What to expect in a bone density test
If you’ve been asked to have a bone density test, here’s everything you need to know.
Bone density tests are commonly used to determine if someone has osteoporosis – a disease that weakens bones, causing them to become thinner and more brittle. This means they’re more likely to break or fracture.
It’s helpful to detect osteoporosis early on to establish whether your bone density has decreased, before you suffer any fractures. It also helps in assessing your risk of developing fractures in future. A bone density test may also be used to confirm a diagnosis of osteoporosis, and to monitor the success of treatment you receive.
What is a bone density test?
A bone density test is used to measure the density of your bones, using X-rays to measure the calcium and other bone minerals within a section of bone. It is different to a bone scan, which is used to detect fractures, cancer, infections and other bone abnormalities. Unlike a bone scan, which usually requires an injection, a bone density test is easy, quick and pain-free.
Some simple bone density tests can even be done at your local pharmacy, but other times it will need to be done at a hospital. If your test takes place in a hospital, you should let your doctor know if you may be pregnant. You should also tell your doctor if you’ve recently received a barium exam or been injected with contrast material for a CT scan or nuclear medicine test. This is because the contrast materials might interfere with your test.
What happens during the test
A bone density test is usually conducted on the areas must susceptible to fractures from osteoporosis – namely the spine, hip and forearm. Your test will likely examine your lower spine bones (called the lumbar vertebrae), the neck of the thighbone, which is nearest your hip joint), and the bones in your forearm.
There are two types of equipment used to conduct bone density tests – a central device and a peripheral device. If you have your test in hospital, it’s normally done with a central device. You’ll lie on a padded table while a mechanical, overhead ‘arm’ performs an X-ray on the area of bone being measured. The test usually takes between 10 and 30 minutes, and exposes you to less radiation than that emitted during a chest X-ray.
If you’re tested with a peripheral device instead, this can sometimes be done in a pharmacy. A peripheral device is a small machine that measures the bone density in your peripheral bones – such as your heel, wrist or finger. However, because bone density levels are different throughout the body, measurements taken at your spine or hip provide greater accuracy. This means that if you test positive for thinning bones during a peripheral device test, you may need a second scan with a central device to confirm your diagnosis.
Understanding your results
The results of your bone density test are reported in two numbers: your T-score and your Z-score.
The T-score is based on your gender and compares your bone density levels with those of a healthy young adult of the same gender. It gives you the number of units (also known as standard deviations) by which your bone density is above or below the average.
If your T-score is -1 or above, you have normal bone density. If it’s between -1 and -2.5, your bone density is below normal, and you may develop osteoporosis in the future. If your score is -2.5 or more, this indicates you likely have osteoporosis.
Your Z-score compares your results to the norm for your age, sex, weight, and ethnic or racial origin. If you have a Z-score of -2 or lower, there may be a cause of abnormal bone loss other than aging. However, if your doctor can identify the cause, you may be able to treat the underlying problem and slow or stop bone density loss altogether.
You can find out more about osteoporosis treatments at BMI Healthcare here or you can make an online enquiry.
Sources
http://www.radiologyinfo.org/en/info.cfm?pg=dexa
http://www.nhs.uk/Conditions/Osteoporosis/Pages/Introduction.aspx
http://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis-treatment/art-20046869
What to expect during a prostate exam
It’s common that men avoid getting their prostate checked as they’re too embarrassed to go. At BMI Healthcare, we want to encourage men to go and get checked and to ensure you are clear on what the prostate exam procedure consists of so we thought we’d set the record straight about what happens during a prostate exam. Knowing each stage of the procedure will hopefully help put your mind at ease and prepare you mentally before your exam.
Why should I get my prostate checked?
The main purpose of a prostate exam is to check for prostate disease or prostate cancer. If you’re over 50 or you’ve noticed any unusual symptoms, we encourage you to book an appointment to be examined.
Who carries out my prostate exam?
The rectal examination can be carried out by medical professionals including, your GP, a nurse or a specialist consultant. Most procedures are carried out at GP surgeries.
Your examiner will completely empathise that this is embarrassing for some people. If you’d rather a GP/doctor/nurse to be the same-sex, please feel free to ask as they’d be more than happy to work around your requirements. You can also bring a relative or a friend with you for moral support.
The procedure
Before your procedure you’ll be asked to remove your lower pieces of clothing and then lie on your side with your knees up to your chest on the bed . We understand it’s an unnatural and awkward situation, but try to relax. The examiner will use plenty of lubricant to try and ease the discomfort.
Your examiner will wear a glove and will examine into your lower rectum. If you feel a little discomfort, don’t worry, that’s completely normal.
Your examiner will then start checking for any abnormalities. These can include:
- Lumps
- Warts
- Rashes
- Haemorrhoids or piles (swollen blood vessels around the anus)
- Any other abnormalities
During your exam you may me feel some pressing against your prostate gland. A healthy prostate gland should be smooth, so your examiner will check for any hard areas or lumps. The pressing shouldn’t hurt, but you may have an urge to urinate. If you do feel any pain or you can’t continue with the discomfort, feel free to say and your examiner will stop.
The whole prostate exam should only take a few moments, but can vary depending on whether your examiner finds any abnormalities.
After your prostate exam
After inspecting, the examiner will them remove their finger carefully and will clean any remaining gel. Bleeding is uncommon unless you have haemorrhoids. You can then take your time and get dressed in privacy.
When you’re ready your examiner will discuss your results and explain further steps if they’ve found anything unusual.
Symptoms
If you’ve noticed you have the following symptoms, please book an appointment to be examined . Our consultants, GPs and nurses at BMI Healthcare are all very experienced and will make you feel as comfortable as possible.
- Needing to urinate more often than usual
- Needing to urinate more at night
- Straining or having difficulties in starting or finishing urinating
- Still feeling like you need to urinate again after you’ve recently been
- Weak flow when you urinate
Remember, not all men have these symptoms, so if you feel you may be at risk, you have a family history or you’re worried, you can still be seen for an examination.
To find out more about prostate cancer, click here, or you can make an online enquiry and a member of the BMI Healthcare team will be in touch.
You can also read BMI Healthcare’s consultant Q&A on prostate cancer where three of their specialist urologists answer common questions and discuss the symptoms and treatment available or find out more on their infographics .
[1] http://www.nhs.uk/Conditions/Rectal-examination/Pages/How-it-is-performed.aspx
[2] http://prostatecanceruk.org/prostate-information/about-prostate-cancer#signs-and-symptoms Infographic – http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer
What to expect when implementing SolveEczema.og site strategies
Section of poster from Citizen Science Association 2015 conference
First, referring to my last post, I noticed the thumbnail of the poster does not load. But if you follow the link to the F1000 site and look at the upper right hand corner of the page, there is a link to download a PDF of the poster to enlarge and view on your computer.
So… What to expect when implementing SolveEczema.org site strategies in terms of timing.
I get this question on occasion — the answer depends on people’s circumstances and what they’re willing or able to do.
I am now of the opinion that removing detergents (as defined in SolveEczema.org) is important for anyone with an allergy problem of any kind, and regardless of the dominant reason for outbreaks, I feel it is important for anyone with eczema to reduce or eliminate detergents, since eczema seems to be a threshold phenomenon. Detergents basically make it so our immune systems “see” more of whatever it is we’re allergic to in our environment. (This is medicine 101 — detergents increase membrane permeability — see SolveEczema.org.)
I have come across many, many people who have said they cleared things up substantially within a week of implementation — usually after focused effort to get really close to 100% compliance with the strategies on the site. If being that proactive is not realistic, then it could take weeks or even months, depending on what you are able or wish to do. Depending on a variety of factors, it could take longer, even much longer. Typically those longer journeys happen for a short list of reasons:
A few things can get in the way of success and make results take longer (see SolveEczema.org for more information):
1) Not implementing close enough to 100% (this is very common), or the “holdout” problem in the household (and this can take many forms — sometimes people think the site strategies are just a matter of changing products and don’t really understand the exposures they still get at home). See SolveEczema.org for details. When this is the case, often when people track down that one remaining major exposure and fix it, everything gets better virtually overnight. I’ve gotten that kind of feedback a lot. Sometimes people will see so much improvement at first, they don’t think a few major exposures like their shampoo or their dirty old carpet will be a problem, for example, so they get lax and don’t get rid of things fully until they get serious about it.
2) Hard water makes washing out old residues just take a lot longer, and makes washing with soap (an important strategy for controlling the other residues) less successful. The whole process ends up taking a lot longer, people’s skin doesn’t heal up as fast, the skin is not as substantial early on, etc. Clearing things up can stretch out to weeks or months. (Though don’t get me wrong, I’ve heard many success stories from people with hard water, it’s just more difficult.)
3) Other allergens like pollen or mold in the environment to an unhealthy degree. (Changes the threshold.)
4) Infections that need treating first before things will clear up. Sometimes these are not obvious as infections at first, and are more an overrepresentation of certain microorganisms. Nevertheless, treatment is sometimes necessary first.
5) Other reasons for the eczema dominate, such as unrecognized food protein allergy or a problem with the health of the gut. (This is where a good probiotic can be very helpful.)
6) The person with eczema has very permeable skin naturally. The younger the child, the more permeable skin is naturally in general. When children are older, partial implementation might be enough to eliminate breakouts while being insufficient to get the full benefit to skin and lung membranes (asthma — see SolveEczema.org).
Things should never get worse, and no one should ever “tough it out”. Always ask your doctor for help if anything does get worse.
I wish everyone a happy, healthy, eczema-free holiday and New Year.
AJ