Pre Op information

All the things you might want to know about the pre op tests, the procedure for booking in, the bedside phones and more.

I thought it would be helpful to those who are planning to go to Brugge for their operation with Dr Dillemans, to share the little details which I had to learn along the way. I am the sort of person who likes to be prepared for everything but I really was walking blind when it came to all the hospital procedures so, now I have found them out first hand, I am sharing them with you !

The day before the operation you are collected by taxi and taken to the hospital. The receptionist will let you know what time the taxi is coming. Be ready at the front door at this time or they will drive off and leave you ! At the hospital, you will usually be met my Marc, who is Dr Dillemans PA. He will show you the ropes, but just so you can prepare in advance, this is how it goes.

Reception is right in front of the entrance doors. To the right there are two machines that dispense tickets like a deli counter in Sainsbury's ! You take a red ticket on this first time visit. The waiting area is beside the entrance, and you wait for your number to be called. You go to the red ticket desk which is the one on the left, and they book you into the hospital system. It's handy to take your passport with you for this so they can verify you are who you are. They will print you off a white card ( credit card size) which has all your details on it which is needed for any departments you visit. It's the hospitals way of tracking where you are. Once you have this, you will be taken up to the 5th floor to wait on seeing the dietician.

On the 5th floor you hand your new white card over to the receptionist and you wait for the dietician to call you in. You will be weighed, and your height measured, and then she will work out your BMI. She advises on post op eating, and asks any last minute questions like, 'have you been taking any medication which we need to know about pre op?' etc. Once she is happy with you, she gives you the forms to go and get blood taken. This is on the 6th floor.

Take the lift to the 6th floor and when you come out, turn right. There is another deli ticket dispenser on the wall which you get a ticket at and wait your turn again. The phlebotomists are very experienced, and they have some very swanky chairs that you can relax in while you get your blood taken. Before you know it, you are done !! Then you return to the 5th floor and you wait on your consultation with Dr Dillemans. It is unlikely that you are the only WLS patient that Dr Dillemans is operating on that week, so rather than spend ages with each of you, repeating the same thing over and over, he likes to do a joint consultation with the option of seeing him privately after this if there is anything else you want to ask. Chances are though, that if you have a burning question, so have the others, so ask away while you are all together. It might help someone else with their query.

Dr Dillemans will go through all your patient notes, and will talk about the operation you have chosen. He will say whether he feels it is the correct procedure for you and will give you more information about how it is done. He will estimate how long it takes in theatre, but bear in mind that this is how long he takes working on your insides, this does not include the anaesthetic time, the preparation of your skin, and the opening and insertion of the laparoscopes. Dr Dillemans has two theatres running at once so his minions do the opening and closing of your procedure whereas he does the fiddly stuff with the stomach resection and re-plumbing. He works his magic and then leaves them to stitch you up. So when he says 45 minutes, know that you will be away from the ward on average 3 1/2 to 4 hours for an RNY procedure.

He will talk about your BMI rather than your weight. He announces this openly in the room which I thought was a little embarrassing, but then I figured out that we were all the same boat here, and we were all here to sort our weight issues out. What is the point in being embarrassed about it when those around you are also large people. Get over it !

The consultation lasts about an hour and then you are free to go back to the hotel. If you have not paid your full amount at this stage, you will be taken by Marc to sort this out. If you are all leaving at the same time then you can share a taxi which Marc will call for you, or reception will do this. The taxi fare is about 10-12 euro or you can catch the bus which stops directly in front of the hospital. Ask for a return or a two trip ticket and you will only pay 2 euro. It's an odd system, don't ask me how they work it out, but it's the cheapest method.

On the morning of the operation have a really good shower (you will miss these for the next few days !!) but do not apply any make up, talc, or deodourant. Make sure your nails are free from varnish too as this interferes with the oxygen saturation monitor in theatre. You will be collected at about 8.15am. You are expected to have taken nothing to eat or drink from midnight. You will be taken to the hospital by taxi and you go to the green ( not red) ticket dispenser today. Wait your turn and then go to the check in desks which are directly in front of you. These receptionists again check your details, your next of kin contact details, your home address etc. They check that payment has been made, and then they will allocate you to your ward and room. This receptionist also has the phone cards for the bedside phones. They don't have any English instructions for them as yet, so you sort of go with the patchy instructions you are given verbally !! I will come to this in a moment.

She will give you instructions on how to get to your ward. Remember that this is a Belgian NHS hospital, and although you are paying as a private patient, you are not treated any differently to an NHS patient. You will not get a private room, but you will get a 2 or 4 bedded room. They try and group the WLS patients together, but in my case, I was sharing a 2 bed room with an 81 year old Belgian lady who spoke very little English. I was on the 10th floor and the view was amazing. The ward was very clean and the staff were generally friendly with good spoken English. You have to report to the nurses station and they will take your details for their own nursing notes. They ask you about your previous surgeries, medications, illnesses, ongoing health complaints. They will have access to your blood results which was taken the day before. If there was any irregularities then they will address them there. If you have a BMI of more than 40 then they ask you to go for an ECG. You will then be shown your room, your bed, your locker, and the nurse call system. The nurse call bell is also the phone, tv and radio control and light switch.

They will bring you a gown and tell you roughly how long you will have to wait before your operation. I had until the afternoon so I was able to mooch about the place, go and get my ECG done, read magazines etc while I was waiting.

The ECG - you go to the 6th floor and follow the directions that start with 'cardio' !! We asked someone in a nurses uniform where we were supposed to go, and followed him. We went through the door opposite the lifts and then turned left and through another door which lead to a ward. We waited in a small waiting area which was bunged with Belgian people !! They came and called for everyone who had the white forms ( which I was given on the ward) and told to go into this little cubicle and take my bra off and put my top back on. Then I was called in to the ECG room and they did the fastest ECG I have ever seen !! The machines are identical to the ones we use here but no sticky pads, she sprayed me with some contact stuff and the electrodes were held on with some form of suction I think !! Anyway, it was over before I knew it !! I returned to my little cubicle and put my bra back on, and waited on the printout. Then I was told to go with the cardiologist who would check me and the ECG to pass me fit for the operation.

Back up to the ward, I got to grips with the phone. The receptionist would have given you a phone card on request. You pay nothing for this card at this time. You go up to the ward and put it in the slot in the back of the nurse call bell handset. Wait about 20 seconds and it will activate. Your number will either be given to you or it will show up on the handset, I really cannot remember !! I think it's the latter. Anyway, this is how it works. The hospital want these cards back when you leave the hospital, so they put a 20 euro charge on them. You get 10 euro worth of calls ( if you use none of this then you get it all back) and there is a 10 euro deposit. Use the handset to let your friends and family know your new number and tell them that the ring tone they will hear sounds like our engaged tone, but let it ring and then you will answer it. It is much much easier if you get folk to call you rather than the other way. You would have to take a trip to the machines in the entrance to put more money on it otherwise and that is a pain. Our phone calls collectively over the 4 days I was there was about 1 1/4 hours but our phone bill was only £5 ( on Talk Talk) so it is not bank breaking for your family to speak to you on the phone there. When you leave the hospital, take this card to the machine in the entrance foyer and put it in, follow the on screen instructions and you will be refunded the 10 euro deposit and any change out of the 10 euro call credit that you have not used. The calls you made will be billed to your home address. It will be less than 10 euro though if you only used the amount that was pre loaded on the phone. I used about 8 euro phoning people so I was given 12 euro change from that machine and expect an 8 euro bill at some stage through the post.

To make a call to the UK dial 0044, then omit the 0 of your area dialing code and then dial the phone number you want. It's as easy as that. They allow you to use mobiles in the hospital too, but we found we had huge problems with the mobiles over there and our call credit was seriously depleted by texts not being sent by the local network and the phones automatically charging for every attempt at sending a text. Each call on the mobile was nearly 50p a minute, and a text was something like 45p a text. When it keeps sending and sending the texts that soon builds up. We moved any unsent text to the draft box and manually sent it when the signal was better. Be warned !! The hospital phone is a much better and more reliable option.

While you are waiting on your operation, here is a top tip which if you are of a delicate disposition then skip this bit, but it is something that will make your post op toileting experience much better.

Go and do a poo !! While you are in theatre, your bowel is being poked at and opened up and re-plumbed. The bowel is a very delicate organ and where it usually rhythmically squeezes (peristalsis) your poo along it, this suddenly stops. The peristalsis starts again by about 2 days post op, but during this time you are kept hydrated by intravenous infusion, and your bowel 'contents' can become seriously dry and brick like. When your bowel starts working again (you will know when you feel it gurgling, or you start to fart again !)  and you finally get the urge to 'go' you're likely to be there for a long time trying to pass this brick. If you pass this before the operation, believe me you will do yourself a huge favour. Have a pee before you go to theatre too. They don't catheterise you so you can imagine what will happen to your bladder control if they knock you out to the point where a machine has to breathe for you. Get my drift ?

OK, it's safe to look back now !! Get your gown on when you are settled in your room. Fret not about it going round you, it will, they are pretty big ! BUT, they are seriously short and you are not allowed to wear anything underneath so I kept my trousers on until they told me I was going to theatre. You will be measured for lovely sexy white below knee anti embolism stockings. These should be tight but not to the point where they are cutting into you. Keep them smooth and wrinkle free at all times because turning them down or letting them wrinkle can actually cause a clot to occur. These stockings are elasticated in a graduated manner, and this is why you need to be specially measured to ensure you are wearing the correct size.

Make sure you take your jewellery off. Yes, all of it. If you have piercings, tongue, belly button, ears, who-ha ( you know who you are !) ..... wherever you have them, they have to come out for the duration of the operation. If you are wearing rings, the same applies. In the UK we can apply tape over the metal and as long as it is well stuck to your skin, then when they use the electric diathermy machine to cauterise the stomach as they resect it, you will not get a burn where your metal jewellery is. However, in Brugge, they insist that all jewellery is removed. If you cannot remove it, then they will cut it off. Spare yourself this and get the jewels off !! There is a lot of diathermy involved in this surgery so don't risk hiding any metal on your body because you will get burnt and it will be sore.

Post op here is what to expect. You will have 5 incisions, but only 4 have dressings on them, the 5th one will be covered with a stoma bag to collect fluid which would otherwise be collecting inside you and causing you pain. This drain will be checked every so often and emptied. The drain is about 15cm long and about 2cm wide and flat like a computer cable. It is made up of several little tubes in a row ( which is why it is flat) and this allows the fluid to flow from where the stomach has been separated from your new pouch. It stays in until 2 days post op. I found it very limiting in my ability to twist or turn, and wipe my bum !! It is taken out in 2 sessions. They cannot take the whole thing out at once because it is a biggun and your body may go into shock if it has the whole thing whipped out at once. I felt so much better even with half of it out, and as long as they are gentle, it really is not too sore. They will apply a big pad over the half removed drain and you can kiss goodbye to the stoma bag forever !! The rest is removed in the afternoon and then you are really flying.

You will be given evian spray post op for your dry mouth. It is quite refreshing and keeps your mouth moist. I was very grateful for it. The drip will keep you hydrated, and they give you zantac through this too, to keep your tummy for getting an ulcer. You stay on Zantac tablets post op when you come home too, for about a month and any time after that if you get any heartburn sensation.

You will be nil by mouth until Friday when you will be given water to drink in the morning. Take it slowly and sip away. Don't gulp it, but allow little amounts to go down at a time and see how you go. In the evening they will bring you a yoghurt for dinner. This is your first food test, so take it slowly ! I managed about 3/4 of a pot. You may not feel full as such, but you will feel a sensation that you should stop. Learn to listen to your new pouch. You cannot drink at the same time as eat so you just need to get used to this new way of life.

On the day of discharge they will bring you breakfast. It will be something like 2 Dutch crisp breads, a yoghurt, and a pot of tea. ( take your own t bags !!!!) This food is put there to allow you a choice, not as a challenge to eat it all. I put the yoghurt to one side and decided to try the crisp bread. These things turn to nothing in your mouth ! I was surprised how easily they went down ! I had jam and low fat spread on them and they were nice. I just took it slowly. Getting used to oral paracetamol was tricky too now the needle was out of my hand. They advise against fizzy drinks, but paracetamol is fizzy. It hurts a bit to get down but when you are discharged they give you paracetamol that dissolves in the mouth. This is much easier, and far more effective too

They will give you about 10 days worth of zantac, paracetamol to last you a few days, and a box of blood thinning injections. They will give you a letter for your GP which just details your operation, and advice about how long to be off work. I was advised 2 weeks. The dietician will make a final call to see you and make sure all is ok, and Dr Dillemans will be round to see you too, to make sure all is well before you go back to the hotel. Once you have had lunch ( mine was minced chicken, mash and puree carrots ) then you can go. Keep Marc's number close by you and call him to see if he will collect you or if he will arrange a taxi for you. Then you are fit to go.

That is it in a nut shell. The operation day and the next day are the most painful ones. You cannot expect to be pain free when you are having major surgery like this. You will be in some discomfort and this has to be expected, but once they get you up and going, go with it. Once you get walking you move any trapped gasses from the operation and this makes your discomfort so much less. You have to force yourself to do this because they will not come and tell you to walk. You will do yourself a massive favour if, once your drip and drain is away, you get going, even a short walk up and down the ward. I made it to the front door and back on the Friday and I felt really good on this. The Saturday I was discharged, I was able to walk steadily about the ward, shower myself for the first time ( yay) and feel human again. The more you walk about the easier the pain gets. Don't stoop, try and walk tall so the healing tissues don't get a chance to heal up with you in a bent pose. You may feel like lying there and not moving because you are too sore, but this is the worst thing you can do, and so do yourself a favour and get moving.

The local restaurants all have soup on their menus but they all seemed to be vegetable, all the time !! It's worth taking some packet soup with you for a change.

We got a taxi back to the airport on the Tuesday morning because pulling a heavy case any distance, and struggling through rush hour Brussels was not a good idea. Marc will arrange this for you if you ask him. It's a good idea so go with it. Make your trip home as easy as you can.

Please see my page about things to pack and take with you. It might help !!