Topic: Whipple Surgery Recovery and Nutrition

Hi Eli:  You have mentioned nutrition after surgery.   Can you give me some of your knoweldge about what to do and what works?  Also wondering how long recovery might be - I know everyone is different - but just an idea.  Thank you!

Re: Whipple Surgery Recovery and Nutrition

Hi Duzalot,

I just want to acknowledge that I saw your message. I will be back on the weekend to tell you about our Whipple experience. Feel a bit tired right now... I was up very early today for our ONC appointment.

Best wishes,
Eli

Re: Whipple Surgery Recovery and Nutrition

Hi Eli:  Thanks for checking in - I really appreciate it.  I was looking at other posts and saw yours regarding your wife's oncology appointment and making decisions.  I hope everything went well.  Rest well and good night.  Will check back over the weekend.

Re: Whipple Surgery Recovery and Nutrition

Hi Duzalot, if you don't mind I'd like to jump in here about Teddy's Whipple, of course remember everyone is different and his was 7 years ago but......They gave him an injection in his room and before he left the room he was sleeping. It was a long surgery, 8 hours, not life threatening but long. He was only in ICU 2 nights and then brought back to his room. It does change the way they eat until a few months down the road. He LOVED chocolate but couldn't stand the taste of anything sweet anymore. Because the surgeon had to cut the head of the Pancreas  he was given insulin only during the hospital stay. The second day he not only went back to his room he was sitting up. I don't recall Teddy loosing more weight after the surgery, it was all before. He had a morphine pump and had little discomfort. It was hard to tell as his pain tolerance was extremely high! He was in the hospital 7 days. Here is a hint: I had my own rare stomach cancer 2 years ago and as we all know with any stomach surgery you get the joy of the tube in the nose! When I woke up I immediately asked for a bottle of Chloraseptic to spray in my throat. The tube never bothered me because of the spray.
Going home: Eating meals will return but it takes time and patience as this is a long recovery. Grazing on food all day works better than a meal. I made comfort food like buttered noodles, soup. Nothing fried, greasy or spicy as the digestive system will be forever changed. I put Teddy on Carnation Instant Breakfast and he loved it. The vanilla with a banana blended in takes the place of a whole meal with all the nutrients any time of day.  OH, dairy was a no, no for him too.Guess that's about it for now, if you have any other questions please feel free to contact me. I am wishing your family all the best.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Whipple Surgery Recovery and Nutrition

Hi Lainy - Please, please jump in at all times!  Thank you so much for your reply.  At first I was worried about telling my Stepmum what this entailed coming from actual experience, but she was so glad to get the information.  I will read her your reply and Chloraseptic will be put on the list.  My baby brother called last night and when I answered he said "hello Duzalot".  He's been spying!  Yay!  I asked him how he knew it was me and he said "doesn't take alot to figure out - you're from Az, Dad had CC and now Stepmum".  I thought that was kindof funny!  But he and his wife are now reading the posts - which is answering a lot of their questions.  Now back to our patient -this is great information - I'm glad to know that Teddy didn't lose any weight.  What was his recovery down-time once he got home?  Also, I've read a little bit about this being done with a laprascope?  Is that even possible?  Stepmum meant to ask the doc, but hasn't yet.  If done with an open incision, is it large or are there multpiple incisions?  Oh the things we think of in the middle of the night....also, I hope you don't mind me asking, but you had also had a  rare stomach cancer, but not CC?  Thank you, Lainy - I appreciate you being here to answer my questions and calm down some of my fears.

Re: Whipple Surgery Recovery and Nutrition

Hi, Duzalot. Don't laugh but I though Duzalot was because you do a lot!!! And you do! I don't mind answering anything.
Recovery again depends on the person. Can't remember how long he was on pain pills, not long but again he had an extroadinary pain tolerance. He pretty much rested for a month then the Doc told him to just take walks to the end of the driveway and back. And then you just increase as you feel you can. Do not push anything as it will all come in due time. In my book anyone who goes through a Whipple is a true hero! Not from pain but all that is involved and the time length for everything. I, myself have never heard of a Laprascope being done. Guess it depends if it will be a true Whipple or a portion. Please know that the Surgeon cannot possibly really know what all is involved until he gets in there. I can't lie to you, Teddy's incision went from side to side at the top of the stomach. He never complained about it though as the meds took care of that. Like Marions says, always hold a pillow there to cough! I am not laughing at you, but you remind me of me. I need to know just what is going to happen. Cut off my arm but tell me what you are doing! Yes, the year before Teddy passed I had what is called a GIST tumor (Gastro Intestinal Stromal Tumor). Like CC you don't know you have it until quite late. Mine was about the size of a small Cantaloupe. They got it all with clean margins, however it can return like CC and you don't know it so I get scans 2 X a year now. I told my ONC that I am not worried about it and if it should return we will handle it then! The only cure like CC is surgery each time. Honestly your stepmum is going to be just fine it all sounds so much scarier but you will all look back and say whew, that's over now lets get healed! P.. Please also remember that Teddy's was 7 years ago and things may have changed a little and may be easier now on the patient.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Whipple Surgery Recovery and Nutrition

Hi Lainy - now I'm laughing!  I'm like you - just tell me. I had a preventive mastectomy 7 1/2 years ago with reconstruction.  My husband said "it's gonna hurt", my plastic surgeon said "it's gonna hurt like hell" but the women that I spoke to that had gone thru it never said it was going to hurt.  OH MY GOD - it hurt like you can't imagine - and I have a pretty high pain tolerance.  I thought it would be like my hysterectomy where I only took tylenol and ibuprofen.  i think if someone had said "we are going to be ripping your pectoral muscles off of your ribs, lifting them and then shoving an expander on each side, which will make the muscles running to your back roar, scream and spasm ALOT" I might have been smarter and taken regular pain meds.  I finally found myself in the garage in a puddle of tears when I came to the conclusion that I needed stronger meds...  if they had only told me.  Sounds like the same incision Teddy had was the type my Dad had for his palliative surgery.  It was like a big upside down smiley face.  This is great the way you have explained it, because my Stepmum is on the hard-headed side (I get that from her) and when I read it from you it's not like me trying to lecture her - it's coming from someone with experience - not the just kid bugging her.  Oh, by the way, my name is Sheri.  My husband and I are Jeepers.  Our rock crawler is Duzrock, our truck is Duzdirt (cause I play in the dirt alot), our jeep hauler is Duzjeep which left us with our Cherokee that Duzalot!  So there is my formal introduction and real identity! 

P.S.  One of the wonderful things I got from my Dad was his incredible sense of optimism.  I must say right now it is waning a bit - you are helping to me to pick it up - Thank you!

8 (edited by eli Sat, 10 Mar 2012 12:00:47)

Re: Whipple Surgery Recovery and Nutrition

Hi Duzalot,

Here you go...

Marina's Whipple lasted about 6 hours. Marina was in good enough shape after the surgery that she went from OR to PACU (post-anesthesia care unit) to the general floor all on the same day. I didn't like the fact that our surgeon decided to skip ICU. It was absolutely nerve-wracking to see her in a regular room with all those tubes sticking out of her body.

Marina wasn't allowed to drink anything the evening after the surgery or the next morning. They gave her small ice cubes to melt in her mouth, to keep mouth and throat moist.

Marina was sitting in a chair on day 2. Not that she really wanted to. It's an exercise that nurses pushed her to do. Apparently it speeds up the recovery. She was able to take a few small steps from the bed to the chair and back. Later on day 2, they allowed her to drink water. Just a few small sips at a time.

On day 3 she was able to walk from wall to wall in her room. I think she was allowed to drink clear liquids on day 3. Ginger ale or apple juice. Again, small sips at a time.

Day 4, she started walking the halls. Short distances two-three times a day. A nurse or myself had to be by her side, just in case. She increased the number of walks and the distances with each passing day.

They introduced some soft foods once Marina was able to pass gas. Ability to pass gas is the green light signalling that "new and improved" digestive tract is open for business. Every bedside visit by a nurse or a doctor started with a question: Are you passing gas? Never in your life will you see so many people interested in your farting habits. For Marina, the magic moment happened somewhere around day 4.

They started with very soft foods like jello, apple sauce, vegetable broth. They added slightly richer foods a few days later. Ensure drinks, low-fat yougurts, puddings. The general idea is that you have to progress very slowly. From water to clear liquids to richer fluids to soft food to solid food. Eat frequent meals small amount at a time.

Marina was ready to go home on day 7. Unfortunately, she caught a small throat infection. The infection threw off her blood counts. The surgeons couldn't figure out what was going on, so they delayed the discharge. They discharged us on day 9, which is still amazing.

Our house has three levels and LOTS of stairs. Marina was able to climb the stairs without any assistance right off the bat. We started going for outdoor walks the next day. That would be day 10 after the surgery. By week 3, she was back to walking her regular route around the neighborhood. 1.5 miles or so. She resumed driving on week 4.

Sometime around week 5 or 6, she picked up Yoga (inspired by AntiCancer book). Mostly meditation, nothing strenuous.

Many Whipple patients go home with an Rx for a high doze of pancreatic enzymes (CREON capsules or similar medication). Marina had enough of her pancreas left so she didn't need that. She followed a very low-fat, vegetarian diet for a few weeks after coming home. Vegetable soups, rice pudding, apple sauce, short noodles, soft crackers, zero-fat yogurt etc. As Lainy mentioned, nothing fried or greasy. Vegetable soup was the main staple food in the first couple of weeks. We blended the soup with a hand-held blender to make it smooth. We added lean chicken soup a few weeks later. Again, we blended it until smooth.

As you can imagine, it's virtually impossible NOT to lose weight with a diet like this. Marina lost 5-10 pounds before the surgery, and another 5-10 pounds after the surgery. Don't remember the exact numbers. She didn't have any unwanted extra pounds to begin with, so she ended up being too thin. We tried adding nutritional drinks like Ensure, Boost, Carnation to keep her weight up. Marina hated the artificial taste so she rejected them all.

Marina started chemo-radiation 10 weeks after the surgery. A tough tough tough thing to do. I can't say that she was 100% recovered when she started radiation. 80%, maybe.

Any questions - don't hesitate to ask!!

Wishing you and your step-mom the best,
Eli

Bonus links from my bookmarks to yours smile

Nutrition after a Whipple Procedure
http://www.pancan.org/section_facing_pa … cedure.php

Whipple Procedure - Nutritional Concerns
http://www.virginia.edu/uvaprint/HSC/pdf/16010.pdf

9 (edited by eli Sat, 10 Mar 2012 11:58:42)

Re: Whipple Surgery Recovery and Nutrition

Re: Laparoscopic Whipple

A few surgeons do it but it's new and uncommon (and, I guess, unproven). When I asked our surgeon about it, he said he was too old for it. He also remarked that so many things can go wrong during Whipple, it's definitely beneficial to have full access.

Re: number of incisions

Marina has one long incision. It goes from the diaphragm down to below her belly button.

Re: Whipple Surgery Recovery and Nutrition

Good to meet you Jeep Sheri! Ditto to everything Eli mentioned as well. You are giving a good description of the incission...definitely an upside down smiley face...huge smile!
One thing I forgot to mention...why Teddy took longer to heal. He had an aborted Whipple the end of August 2005. The surgeon said to us that the longer he is in surgery the better it is as he would stop the surgery if the CC had spread. 4 hours had passed and out he came. He said I have good news and not so good news. My 1st thought was, well, I didn't hear bad! Turns out that when T had his Endo the dye leaked on the Pancreas and about destroyed it and the Surgeon could not cut the head in that condition. With the condition the Pancreas was in the Doc and us could never figure out why T didn't have pain!!! Anyhew, we went to my son's (we were out of town when all this happened) so T could do some healing of the Pancreas. About 2 weeks later he started to get so sick we had to take him by Ambulance to the Hospital. He had developed a double e coli infection. So, now he was in the hospital for 9 days on anti biotics. Finally the Doc said we need to go in, the Pancreas should be a lot better. It was, the 2nd Whipple was done but his recovery was longer due to all he went through. 
Sheri, I am so sorry that you have had to go through so much yourself. Guess what we go through makes us the way we are today.

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Whipple Surgery Recovery and Nutrition

Hi Sheri,

I just saw your question about the Whipples and can it be done via a Laprascope. And yes as I understand it can be done and indeed one of our members here, Julygirl had this done in 2009. She is from the UK and this procedure was done here at the St James hospital in Leeds. So yes it is possible but I don't know how common this procedue is in the USA.

My best wishes to you,

Gavin

Any advice or comments I give are based on personal experiences and knowledge and are my opinions only, they are not to be substituted for professional medical advice. Please seek professional advice from a qualified doctor or medical professional.

Re: Whipple Surgery Recovery and Nutrition

Thank you all for taking the time to reply.  Lainy and Eli:   I read everything to my Stepmum and she sends her thanks as well.  This is all so helpful to her so that she can have some great guidelines as to what to expect.  She is one amazing lady - her strength, courage and good humour are awesome!  She has a lot of pre-op this week so she will be busy.  I'll be heading down there on the 19th, with surgery the 21st.  Will keep you posted.  God bless and thank you again!  Sheri

Re: Whipple Surgery Recovery and Nutrition

I had a my gallbladder removed along with Roux-en-Y hepaticojejunostomy which is somewhat similar to the Whipple procedure without the removal of part of the Pancreas last August for suspected CC due to a stricture in my bile duct causing jaundice (which was thankfully benign).  Like others have said the surgery lasted about 7 hours, when I woke up I had a lot of tubes sticking out of me, spent just under a week in the hospital (went in for Surgery 6 am on a Friday, released at 5 pm the next Thursday.  If you want to read the details you can look back at my previous posts that I made while it was all going on.  The first few of weeks that I was home I was very limited on what I could eat, nothing at all greassy (lots of jello and applesauce), I could not even eat a regular triscuit cracker without it causing digestive issues.  Over the last 6 months my ability to eat greassy (used in its mildest sense) foods has slowly improved, first it was simple things like crackers, and lightly buttered toast, by New Years I had successfully eaten a slice of pizza as well as a burger cooked on the bbq grill.  These last two accomplishments were not without some rumbles from my digestive system, but I did avoid anything too dramatic.  For the most part breaded deep fried items are still off limits at least in any meal like quantitiy (I can tolerate a bite or two, but something the size of a fried chicken strip is a recipe for hours of digestive issues).  Surprisingly enough my abiltiy to tolerate stir fried items is better than any other type of greassy food.

Ike

Re: Whipple Surgery Recovery and Nutrition

Thank you Ike - I'll pass this on to my Stepmum.  She is scheduled for this coming Wednesday for her surgery.  Who would think we would all be so happy for this to happen......!!!!  I'll look back on your posts and get more information to her.  Thank you again!

Re: Whipple Surgery Recovery and Nutrition

Duzalot! As you read our posts you will see that Surgery is our most favorite word! Teddy used to say, "OK, so now we know....let's get it done!". Wishing your Stepmum and all of you the very best!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Whipple Surgery Recovery and Nutrition

Hi Duzalot,
My dad had a whipple in January 2010 and had a fairly straightforward recovery.  I just wanted to add a couple of points that occurred to me.
1.  My friend who's a doctor said to my dad about laparoscopy 'there's a saying in medicine - big mistakes are made through small holes' - although I guess a small hole would have a much quicker recovery time.
2.  In the UK we don't seem to have any approach to the diet in whipple patients - although we asked and asked they just gave my dad regular hospital food - his first meal after the whipple was 5 days later (when they were sure he wasn't 'leaking') and they gave him sausages!  Can you imagine!  Anyway it didn't actually do him any harm but after he got home my mum was quite careful with what to feed him.  He found that he has to take Creon constantly otherwise he gets diarrhea - I guess from malabsorption.
Fingers crossed for your stepmum.
Kate

Re: Whipple Surgery Recovery and Nutrition

Kate, I just wanted to pop in and say HI and how good it is to see you! Hope everything is going well for you and thanks for the suggestions. Again so good to see your smiling face!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.

Re: Whipple Surgery Recovery and Nutrition

Hi Lainy and Kate!  Thank you for your wishes and Kate for more information on after-surgery nutrition.   I am just so excited right now and it's 'cause of that word:  SURGERY!   My Stepmum has been scheduled for this coming Wednesday - she has done all of her pre-op (lots of it) but I was still holding my breath regarding the insurance (HMO and out of area) and it's all approved.  YAHOOOOOO!!!!!!!!!!!!  Time to get this done!  Lainy, we're supposed to get some big weather and you too.  I was leaving on Monday, then was going to go tomorrow, now back to Monday, maybe Tuesday.  Oh my, little challenges along the way - but it's o.k. 'cause we're headed to SURGERY!!!!  Yay, yay, yay!  Thank you again and I'll let you know how everything goes.

Sheri

Re: Whipple Surgery Recovery and Nutrition

Hey, Sheri, I have been hearing for 2 days now what you are about to get, good luck. We are going to get wind and lots of rain. We need the rain down here.  I am so happy for you and your Stepmum's surgery!!! Will be anxiously awaitng word from you. Tell her I am praying for God's hands to come through the surgeons hands!

Teddy ~In our hearts forever~ATTITUDE is EVERYTHING
Any suggestion I offer is intended as friendly advice based solely on my own experience. Please consult your doctor for professional guidance.