Fasting before surgery

[FixitJosh]

I am donating May 4. I was told that it would be good to fast 48hours before surgery....both for myself and the surgeon. Does anyone have any thoughts on this or have done that? I do fasts frequently, so not an issue normally for me. Thanks to everyone here.....I have appreciated your comments and suggestions.

[Philly57]

I am a surgeon and kidney donor. I don’t believe your information is accurate. You should eat a light meal the evening before surgery. Nothing heavy late at night. You must not eat anything after midnight. The newest data suggest you should drink plain water up until 2 hours before surgery to avoid preoperative dehydration. There are also some preop carb/protein drinks some hospitals are recommending. Best of luck.

Ask surgeons to use a muscle sparing Pfanensteil incision for kidney extraction. It hurts less than cutting through 3 layers of abdominal wall muscle (extending port site technique — painful with longer healing time). There are persuasive articles in medical literature suggesting Pfannensteil extraction is best.

[FixitJosh in reply to Philly57]

Hello Philly57, thank you for your reply....great to hear from you. I will bring your suggestions to my Pre-Op appt. at Emory Clinic on April 22.

In terms of recovery, I have family with me at Atlanta and them home for almost 2 weeks. Do you think that is enough so that I can then take care of myself after that? I believe myself to be in good condition, doing 5-6 miles walks everyday, and hikes each week of 10+ miles, and exercise and do push ups, etc. regularly, and I eat a good whole food diet, sort of like Ketogenic with low starchy carbs, and lots of non starchy veggies, small piece of meat/fish and healthy fats in moderation. I do fast regularly and do intermittent fasting a lot. I think it is a great way to go. I dont have to go to work, so nothing urgent right away. How soon can I get back to exercising and longer hikes?

Congratulations on your donation! I am hoping that after I recover, I can get more people to donate.....at least that is my plan.

thanks again for your response and I look forward to hearing from you again. I will keep you posted as to my journey, if you like.

[Philly57 in reply to FixitJosh]

It depends on your incisional pain. An abdominal wall extraction site, is likely to be more painful than a muscle sparing extraction site. I was useless for 9 days, could barely get off the sofa without severe incisional discomfort. By 14 days I was very functional. I did not even consider going back to strenuous exercise until 3 months postop. Even now, at 4 months, I have some residual abdominal wall pain where the muscles were cut, but this pain does not limit me. By the way, there is testicular pain (on donation side) that lasts for about 3 months due to venous pressure (after gonadal vein is cut). This testicular pain should stop when collateral venous flow is established. The testicular pain was a little scary, but did resolve eventually. Good luck. Ask them to use Pfannensteil incision for kidney extraction. This is the incision obstetricians use for C-sections and spine surgeons use for anterior lumbar fusion surgery. It is a well-tolerated incision.

[FixitJosh in reply to Philly57]

Hello Philly57, So, we went for our Pre-Op appointment on Thursday, and I met with the surgeon, and I asked about the Pfannensteil extraction that you mentioned. He said that was a good procedure, but what he was going to do was to make the cut to remove the kidney a vertical cut, not a horizontal cut. It will be from the belly button down about 2 inches, therefore going through less muscles and also healing faster. He said this will allow him enough room to extract the kidney. It sounded good to me and he was quite confident that this was the way to go. Of course, it will be laparoscopic. I will be giving up the left kidney. He said there was no bandage, but only something he called "skin glue" to hold the incision together, and that i could take a shower any time, even while still in the hospital...amazing!!

From our meetings with everyone, it looks like a GO at this point, all we have to do is take Covid Tests on Monday, the day before, but we both have had 2 shots, so i doubt there will be any problem with that....so, it looks like May 4 will be the day. He said fasting was necessary, but OK...just nothing after midnight, so I will certainly do at least 12 hour fast, which is less than my normal 18/6 intermittent fasting.

thanks for your info....always good to learn something. i appreciate your concern.

[FixitJosh in reply to FixitJosh]

Also, I asked about the testicular pain, and he said it was very rare....yes, they do cut a tube that drains the testes, but he said they have other ways to drain, so it is rarely a problem....so, maybe you were just one of the unlucky ones in that area.

[Philly57 in reply to FixitJosh]

The vertical incision will also be muscle sparing, which is less painful than cutting through 3 abdominal wall muscles. The vertical scar is more visible than horizontal bikini line scar, but generally not a big deal for men. I think the testicular pain is more common than admitted, but have faith it will, more likely than not, go away. You are doing a good thing, I am sure all will go well. The surgeon and preop team aren't recommending drinking water 2 hours before surgery to avoid preoperative dehydration?

[FixitJosh in reply to Philly57]

Hi, thanks again for your reply. All seems to be going well and I feel good after discussing things with the doctors. I will ask about drinking water before surgery, I dont think that came up. Sounds reasonable. As you probably already realized, I made a mistake in my last reply to you.....there was suppose to be a "NOT" (fasting was NOT necessary). I am sure it will go well, and almost starting to look forward to it....maybe it has just been such a long time now (applied at Emory 2-2020), that I want to see it done. So, one from today is the Covid test, and then Tuesday is the big day. thanks for your concern and kind words.....always welcome, and I will let you know how it turns out.

[Philly57 in reply to FixitJosh]

Is the recipient your family member?

[FixitJosh in reply to Philly57]

Yes, my recipient is my partner of 16 years....who would have thought that 16 years ago we would be a match for a kidney exchange!! God does have a great sense of humor.

[Philly57]

So? FixitJosh, how did you make out. Hope you are feeling good.

[FixitJosh in reply to Philly57]

Hello Philly57.Thanks for reaching out to me.... I had you on my list of things to do.

So, all went very well....I was amazed at how easy it all was. Surgery at 7:30AM, then I was in recovery and awake by noon, and talking on the phone to family and friends all afternoon, who couldn't believe it was me. Very little pain anywhere...liquid diet for that evening and the next morning. By the next day at 10AM I was removed from tubes and up and walking down the hall to visit my recipient a few times a day. He is doing well too, but of course, has a lot more to deal with than I do. I went to the Mason Guest House (at Emory U. Hospital) the next day (2 nights in hospital) where I stayed for a week....wonderful place to recuperate, better than home!! I was told I could walk as much as I wanted, so, starting on Friday, the day after I got out of the hospital, I started walking....10K steps, then 12K steps, then 15K steps...I walked all around. I felt great....took a few of the pain meds, but not many and only before bedtime, then just Tylenol after that as needed, and stopped that in about 4 days after leaving the hospital. Getting out of bed was a bit tough, but manageable. I would say my pain level throughout the entire ordeal was no more than a 2. I am home now, driving well, walking, cooking, going to church, shopping (small weights). Honestly, I have had stomach aches worse than this:!! I had my Post Op meeting May 13, and the doc said everything looked great. Just no lifting over 10 pounds for another month.

On the emotional side, I cant tell you how blessed I feel knowing that Dave (the recipient) now has a new lease on life, with hopefully 20+years of no dialysis and feeling well. What a wonderful blessing that is to him, but also to me! Words cannot express the joy and contentment I feel everyday knowing the difference I have made to another person. Honestly, I feel I got the better deal of the two of us!

To all you would-be donors out there.....go for it!!! If you are healthy enough to donate, most likely you will still be quite healthy for the rest of your life, because you have taken care of yourself, and will continue to do so, maybe even better care.

Thanks again for your help.....June 15th is my 6 week date and I cant wait to get back to riding the bike, doing the push ups and sit ups, and hiking all those mountains again!!!

[Philly57]

Just reading this post now. Sounds like the vertical incision worked out great for you. I think all the transplant surgeons should use a muscle-sparing incision to avoid the severe postop pain that I had for the first 9 days. I am almost 6 months out from surgery and, when I work out, I still have a little pain at the extended port extraction site in the left lower quadrant. The left testicular pain is completely gone now. I'll let you know about my eGFR.

[alimesoda]

Welcome to the donor club! I’m thrilled to hear your smooth recovery FixitJosh!

I donated to my husband in 2018 and had a very similar experience— only a few days of gas pains in my shoulders — no where near incision or surgical area. I fasted before and ate very small light meals after, walked as much as I could, and took no oral pain meds (I truly didn’t need any!) starting day 2.

Our surgeries were at New York Presbyterian where the donors surgeon removes the kidney laparoscopically via a single port. There is barely any noticeable evidence of my surgery now— amazing!

Like you, I am advocate for this life changing surgery for both the recipient and the donor!

Congratulations on being such a generous partner!