Doc's office says I can't vape before surgery tomorrow

[ancientgeek]

Making no attempt to dispute the qualifications or competence of the doctors tending to OP:

My wife went in for extensive shoulder repair in July. In pre-op we met the anesthesiologist and had a delightful discussion of vaping and vaping equipment (he was a vaper himself). he left to do other things as we waited for the surgeon to arrive. My wife dug around in her purse found her e-cig and had a good vape. The anesthesiologist spotted her and only said, with a grin, "I don't think that's allowed" and shook his head. So busted.

Surgery proceeded on as planned and everyone has marveled at her speed of healing and recovery.

Best of luck with your surgery.

 

[Racehorse]

Of course they would use you as an advocate for others. You followed their rules. Do you honestly expect them to use someone that continued to use nicotine and had nothing happen to them?

This assumption on your part is interesting.

The advocacy was a group of volunteer women, from an independent forum site much like this one, who helped other women get thru a surgery. We were not connected in any way, to any hospital, surgeon, doctor, etc.

We had no "agenda".

I knew there wasn't a whole lot of research or long term studies on vaping as of yet......what I didn't know is that there is data showing outcomes of surgeries and especially plastic surgeries of individuals who are on nicotine.

Singular anecdotals of "I did X and nothing bad happened", by people with no medical training or even years of surgical experience, seems an okay replacement for that data here, I guess.

I hope you don't consider me "anti vaping" because that concept doesn't seem prudent to me. In good conscience, I will continue to NOT recommend nicotine for patients undergoing any kind of vascular or plastic surgery.

 

[Eranda13]

Racehorse, I'm not suggesting that your doctors don't know what they're talking about. I'm suggesting that not ALL doctors know enough about vaping or even nicotine to have a well informed position on the subject. I laid there in the pre-op room and asked the question of the anesthesia tech, the anesthesiologist, and my surgeon- and none of them had a definitive answer for me. In fact, all they could say was that they would have to "do some research" on the subject.

Doctors are human beings, and while they are usually very knowledgeable about their specific specialty, they are not medical savants who know everything about every medical condition and situation that exists. My regular doc wasn't at all convinced that I had gallstones when I went for the initial exam and he asked me about symptoms and examined me. He sent me for an ultrasound "just to check". I guess he was wrong, because they pulled a 7/8" gallstone out of my inflamed and previously infected gallbladder a week ago. Why? Because he's a GP, not a specialist. It's his job to know what warrants further testing and what tests are needed- not to be an expert in every medical specialty.

Anyway, I'm sure it's possible that there are some situations in which refraining from nicotine has a valid purpose. Just not sure mine was one of them.

 

[Racehorse]

Racehorse, I'm not suggesting that your doctors don't know what they're talking about. I'm suggesting that not ALL doctors know enough about vaping or even nicotine to have a well informed position on the subject.

True!

Anyway, I'm sure it's possible that there are some situations in which refraining from nicotine has a valid purpose. Just not sure mine was one of them.

True!

BTW, I wasn't disagreeing with you directly. I was answering some posts that appeared in the topic afterwards. Of course all doctors are fallible.

I was saying that, with surgeons who have 20 years experience doing ONE kind of surgery, who can show actual outcomes in %, from their very own practices, (not a white paper, etc. ) of how their patients on nicotine turn out and how patients not on nicotine turn out, then I would defer to that information.

^^^^^ (and for taking that learned advice, I basically got called a "shill for Big Pharma by Robino1, which was illogical. )

Because, I don't think you can get better information than that. And i do find it odd that anyone would think that wasn't a real "good bet".

That is like a successful horse trainer of 40 years, who has a 60% "in the money record" on a particular age and/or gender and type of race .......... you find out he/she is running that kind of race, with that kind of horse tomorrow, and I can tell you that statistically, that comprises a "very good bet".

I agree with you though, if I were having a certain surgery, and my GP or someone else was throwing around numbers or theories, I would want to speak to somebody who had actually done 2,000+ of the exact same surgery I was having, and then I WOULD take their advice.

It's simply called *good odds* .

And, in surgery and health, or horse racing, you take the good odds and the good bet. Unless you want to lose.

 

[Myk]

I agree with you though, if I were having a certain surgery, and my GP or someone else was throwing around numbers or theories, I would want to speak to somebody who had actually done 2,000+ of the exact same surgery I was having, and then I WOULD take their advice.

You picked the wrong trainer.
You picked the guy who's breaking foals to be ridden not the guy who trains them to race.
Surgeons likely never see a patient all the way through to the end of healing. They're busy off cutting up 2000 other people. Who you should ask is a post op nurse, but then again that's "just" a nurse and not a doctor. Even your GP is likely to have more experience with healing than a surgeon.

I asked my niece who's a nutritionist about IBD diets. She told me what I already knew, that it's difficult because it's so individualized. Like my other niece who's a post op nurse and deals with IBD patients (who aren't really post op but are sent to her) she had problems comprehending I'm one of the 10%, even though she just got done talking about those rare instances that make IBD diets hard to figure out.
I asked her about an odd thing were I have a major problem with cheddar cheese but can deal with white cheeses. Her professional and specialized answer with probably tens of thousands of patients experience was worthy of Facebook and fad diets. It was only at the end she threw in a more reasonable professional answer as a possibility.
Her fad diet bias is who she is. Her profession has not changed that.

BTW, "I will continue to NOT recommend nicotine for patients undergoing any kind of vascular or plastic surgery.", aren't you just another non-medical person stating your own anecdotal experience?
I will also continue to recommended nicotine of Ulcerative Colitis people, but I temper it with reason and give some leeway for the individuals.

 

[DW82]

I'm actually surprised by this. I've had three surgeries and have been under anesthesia more than that for procedures, and never have I been told to avoid nicotine. They all knew I was a smoker too. Maybe doctors here just aren't as vigilant with patient before and after care.

 

[Barbara21]

<snip>
I was saying that, with surgeons who have 20 years experience doing ONE kind of surgery, who can show actual outcomes in %, from their very own practices, (not a white paper, etc. ) of how their patients on nicotine turn out and how patients not on nicotine turn out, then I would defer to that information.
<snip>

Racehorse, I am not agreeing or disagreeing with anyone here, including you. As a RN, I know there are many factors that go into how a person reacts to surgery (or whatever) that it's hard to make generalizations. No need to go into that further.

But one thing you mentioned interested me (the part I bolded above). I would venture that the vast majority of the surgeon's experience has been with patients who got their nicotine through smoking. I'd be curious to see further research.

 

[CommaHolly]

IMHO,,,,,,it all has to do with being sued,,,,,,

if one study,,,,,,,ANY STUDY,,,,,,,,shows the slight POSSIBILITY that healing is faster without nic,,,,,,,

they are going to recommend you NOT use it,,,,,,,,,,,,,,so they don't get sued for not recommending that,,,,,,,

afterall, abstaining won't hurt you,,,,,,,,,,,,if there's even a .03 percent chance nic WILL hurt you,,,,,,,why not recommend it? (from their POV I mean)

 

[Robino1]

IMHO,,,,,,it all has to do with being sued,,,,,,

if one study,,,,,,,ANY STUDY,,,,,,,,shows the slight POSSIBILITY that healing is faster without nic,,,,,,,

they are going to recommend you NOT use it,,,,,,,,,,,,,,so they don't get sued for not recommending that,,,,,,,

afterall, abstaining won't hurt you,,,,,,,,,,,,if there's even a .03 percent chance nic WILL hurt you,,,,,,,why not recommend it? (from their POV I mean)

I'm glad you added the "from their POV"

 

[Racehorse]

I will also continue to recommended nicotine of Ulcerative Colitis people

Which has nothing whatsoever to do with vascular surgery, or surgery that necessitates cutting through tiny blood vessels.

Which is what I was talking about.

I did not say that nicotine was not beneficial to some other conditions......

So how does the beneficial effect of nicotine on Ulcerative Colitis relate to the effect of nicotine on vascular surgical patients?

Or do you believe that nicotine is NOT a vaso constrictor in the first place?

 

[Racehorse]

Surgeons likely never see a patient all the way through to the end of healing. They're busy off cutting up 2000 other people. Who you should ask is a post op nurse, but then again that's "just" a nurse and not a doctor. Even your GP is likely to have more experience with healing than a surgeon.

Statements like this do WORRY me that many people choose very bad medical personnel. I'm sure there are many of bad ones, too.

However, every surgery I have ever had, esp. the complex ones, I was seen in follow-up, directly by my surgeon. Yes, the surgeon who performed the procedure. Anywhere from 2 post op visits to 12 post op visits.

So I would have no reason to ask a nurse or GP.

Are there actually surgeons who do not follow up with their patients? That really is scary, but I wouldn't hire anyone like that in the first place. Of course, if your appendix burst and you need emergency surgery, you can't choose, but 95% of surgeries are not emergency surgeries, and people do get to interview surgeons and ask questions.

I have never had a GP who provided post surgical intervention. They are not specialists and really cannot perform that function........and should not have to.

 

[peejglass]

Thanks for following up with the post-op update! Glad to learn you are doing well.

One of the two orthopedists I talked didn't really know much about e-cigarettes. The other did. Both knew a lot about NRT use and based their recommendations on that experience.

Gotcha so their though was likely that although vaping is different than many NRT's it is probably SIMILAR in the effects it has on anesthesia and stuff like that? If that is the case it's a good thing because many NRT products actually have been tested in situations like this so it could be less uncharted territory to cross through than it may seem.

 

[Myk]

Which has nothing whatsoever to do with vascular surgery, or surgery that necessitates cutting through tiny blood vessels.

Which is what I was talking about.

I did not say that nicotine was not beneficial to some other conditions......

So how does the beneficial effect of nicotine on Ulcerative Colitis relate to the effect of nicotine on vascular surgical patients?

Or do you believe that nicotine is NOT a vaso constrictor in the first place?

The OP was about PRE-op not post-op healing. So you can stop claiming everything else has nothing to do with whatever you want to talk about. It is all you folk using healing as the excuse that have nothing to do with this.
Pre-op is, "don't ______ after midnight.", it is most likely all about anesthesia but may also be about the procedure. Post op is, "don't __________ for ____ weeks after.", and is about healing.
When there's a thread saying "Doc's office says I can't vape for 6 weeks after surgery tomorrow." then you guys can start talking about healing and dismiss everyone else.

If you've ever seen pictures of Ulcerative Colitis you wouldn't be excusing it away because it doesn't have anything to do with tiny blood vessels.
When they cut through tiny blood vessels they don't stitch them all back together. Nicotine boosts blood vessel growth, which would replace those tiny vessels.

For you to ask "Or do you believe that nicotine is NOT a vaso constrictor in the first place?" tells me you don't bother reading what other people write. I said that is one of the suspected reasons it helps UC so why wouldn't I believe it?
Do you think bleeding more during and after surgery is a good thing? Why do they tell you not to take blood thinners many days before surgery?

Statements like this do WORRY me that many people choose very bad medical personnel. I'm sure there are many of bad ones, too.

However, every surgery I have ever had, esp. the complex ones, I was seen in follow-up, directly by my surgeon. Yes, the surgeon who performed the procedure. Anywhere from 2 post op visits to 12 post op visits.

So I would have no reason to ask a nurse or GP.

Are there actually surgeons who do not follow up with their patients? That really is scary, but I wouldn't hire anyone like that in the first place. Of course, if your appendix burst and you need emergency surgery, you can't choose, but 95% of surgeries are not emergency surgeries, and people do get to interview surgeons and ask questions.

I have never had a GP who provided post surgical intervention. They are not specialists and really cannot perform that function........and should not have to.

In my own recent experience and everyone I know's recent experience I'd be more worried that your surgeons are not as special as you've been lead to believe (or it was a long time ago, yes 20 and 30 years ago my experience was what you describe, not any more). Even the tough cases I know that get sent to Chicago or Mayo get follow ups with local GPs or CNSs and you don't get surgeries done by bigger superstars more than they get and big superstars don't have time to do office visits 12 times per surgery.
I even know a guy who had brain surgery a while ago that only saw the actual surgeon a couple of times.

I don't worry at all that I see my GP every 4 months and the gastro CNS every 6 months. I know my GP got read up on my needs when I became his patient. I actually have them teach me how to keep an eye on myself. It really doesn't take a specialist doctor to do these things which is why medical is going to so many advanced nurses now.
My sister doesn't like the fact my brother-in-law only sees the surgeon for surgeries and a practitioner for everything else but that's more of a financial thing, medical does it to save money but don't pass it on.