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

[Criticalmass]

Dammit, I should have picked up some zero nic juice for before this surgery tomorrow, but it never occurred to me they would tell me I couldn't vape at all. I even asked about a nic patch and they said "no nicotine of any kind". Is there any medical reason for that or are they just being Nazis about it?

They do have valid reasons for it. Nicotine can interact with the anesthetics. They have to change doses based on how much you smoke per day. You do not want to be waking up in the middle if the operation. That would be bad.

One of Tue reasons I burn through painkillers so fast has to do with the nicotine. I have to have double doses of whatever they give most people just so it will last 2 or 3 hours instead of 4 to 6.

Sent from my Astromech in a galaxy far, far away. The force is with me. so is Mr. chicken.

 

[suspectK]

Did anyone even bother to read this scientific paper before commenting? The nicotine in this study was not inhaled, it was applied to a wound. It is not applicable to this discussion of vaping before surgery.

And then there's this; Nicotine Accelerates Angiogenesis and Wound Healing in Genetically Diabetic Mice

This particular study floored the scientists. They took everything else into account and thought they would see a reduction in blood vessels and flow, turned out they saw new blood vessel growth. Just my honest opinion, but I believe previous studies never took the nicotine out of the smoking, something we're still fighting.

Personally, I had my thyroid removed almost a year ago by the head of a teaching hospital's surgical endocrinology and oncology department. I asked him specifically about vaping before the surgery and his comment was "Vape away, it's not smoking."

I don't understand your point. I'm hoping it is in the direction of something metabolized has a different reaction than just looking at what it does when directly applied to cells.

 

[Coldrake]

well gosh, that sounds rather rude

That's because it is.

 

[Myk]

They're being somewhat control freaks (anti-smoking), somewhat paranoid (something could happen), somewhat realistic (it's possible it could cause something), somewhat ignorant (I doubt if they know anything about how vaping interacts with surgery).

I vaped some and I vaped low nicotine because they lied to me about it.
They told me not to smoke. I asked about vaping, no. I asked about 0mg, no. They said it was because it makes you swallow too much.
Wrong answer. Vaping dries you out plus I already know they tell you absolutely no water but if pressed they don't expect you to be gagging because your mouth and throat are completely dried out.
They give these absolute no answers because they figure no matter what they tell you that you won't follow their instructions. If they tell you that you can have sips of water they figure you'll sit down and sip a whole glass of water. If they tell you that you can have a cigarette you'll hot box 5 before walking in the door.

 

[CES]

It's too early in the morning to find links to all the the references for this, so take it for what it's worth..

.. nicotine (not smoking, just nicotine) has all sorts of different effects, in part depending on which nicotinic receptors are activated in which part of the body or brain. There's data that indicates that nicotine causes some vasoconstriction, but other data that indicates that it contribute to new blood vessel formation (angiogenesis). Nicotine can contribute to wound healing and modulate pain, but can decrease bone healing. Apparently the effects on bone healing are mediated by decreasing the levels of bone morphogenic protein (BMP2), a factor that is needed to initiate the growth of new bone.

 

[blondeambition3]

Listen to your doctor's advice, suck it up, and do what they say.

They are doctors, after all.

They're advising you to do what is optimally best in said situation. I would follow that advice implicitly.

ditto!

 

[Mark Anthony]

Hoping that your surgery went well!!!

 

[twgbonehead]

Did anyone even bother to read this scientific paper before commenting? The nicotine in this study was not inhaled, it was applied to a wound. It is not applicable to this discussion of vaping before surgery.

Yes, localized administration can be very different from systemic!

Not only that, it was specifically relating to diabetic mice. Diabetics also have problems with bone healing (and often very severe problems!). The fact that nicotine might counteract one of the pathways in diabetics that impairs healing doesn't mean that it is good for non-diabetics.

It has been very well established that smoking causes problems with healing both bone and soft-tissue. It is very likely that there are multiple causes of this. Carbon monoxide impairs the ability of the blood to carry oxygen. Tars obstruct the lungs, making oxygen intake less efficient.

However, there is also a lot of evidence (although many still don't see it as conclusive) that nicotine also plays a role. Slower healing rates have been observed in people using the patch, for example, and some experimental work has been done specifically testing whether nicotine does play a role in this (and those, in general, appear to conclude that it does impair bone regrowth and healing).

I do agree that Doctors (and nurses) often give a pro-forma list of do's and don'ts before any surgery (and malpractice suits are a major cause of this). But for this particular issue there's ample reason to believe that it's a real and significant concern.

 

[DaveP]

I'd follow the doctor's advice and play the game. You can vape to your heart's content after you get home. Unless you are chain vaping 36mg juice, you probably aren't getting nearly what you got from smoking.

However accurate the information may or may not be, it's said that we get 10% to 30% of the nic level we got from smoking cigarettes. Most of the nic you get from vaping is absorbed through mucous membranes. The lungs don't absorb much at all. The droplets of vaping mist don't make it all the way to the alveoli because they are much larger than the ash particles of smoke. The mist droplets condense early on in the larger bronchial tubes and work their way back out through the action of cilia and the cough reflex.

 

[Myk]

Yes, localized administration can be very different from systemic!

Not only that, it was specifically relating to diabetic mice. Diabetics also have problems with bone healing (and often very severe problems!). The fact that nicotine might counteract one of the pathways in diabetics that impairs healing doesn't mean that it is good for non-diabetics.

It has been very well established that smoking causes problems with healing both bone and soft-tissue. It is very likely that there are multiple causes of this. Carbon monoxide impairs the ability of the blood to carry oxygen. Tars obstruct the lungs, making oxygen intake less efficient.

However, there is also a lot of evidence (although many still don't see it as conclusive) that nicotine also plays a role. Slower healing rates have been observed in people using the patch, for example, and some experimental work has been done specifically testing whether nicotine does play a role in this (and those, in general, appear to conclude that it does impair bone regrowth and healing).

I do agree that Doctors (and nurses) often give a pro-forma list of do's and don'ts before any surgery (and malpractice suits are a major cause of this). But for this particular issue there's ample reason to believe that it's a real and significant concern.

I know you're replying to someone on the topic but you're mostly all talking about healing for pre-op prep instructions.

Healing is why you wouldn't have nicotine for 6 weeks after surgery, not why you wouldn't have nicotine for 6-12 hours before surgery. Nicotine takes 3 days on average to clear a system. It would be greatly cut down by 6 hours but there has to be a dose you could take 2 hours before.
Otherwise it would be like blood thinners and you wouldn't take them days before as part of the prep.

From what I gathered talking to the CRNA before I went under (amazing how refusing to let them proceed brings them all into your room) you would get much different answers if pre-op prep was treated as applying to the individual and by a specialist who can actually answer the questions.

 

[hazarada]

Nicotine constricts blood vessels for up to 24h depending on the person, that in turn makes you heal slower and makes blood clots more likely as your body increases hemoglobin in blood to compensate for the constricted size of the vessels.

 

[yzer]

I had surgery for a broken leg on October 5. This was a tib/fib, full fracture of the tibia with a rod and screws placed into the tibia. The two orthopedic surgeons both advised me to quit nicotine for the recovery period. I used a 14mg nicotine patch while awake in the hospital during the three day hospital stay. Aspirin was prescribed as a blood thinner.

When I got home I made up a batch of zero nicotine juice and used that until November 1. I switched back to nicotine e-liquid at that time.

Aside from the effect of nicotine on blood circulation I was concerned about the effect of nicotine on stem cell production. To heal bone, stem cells will produce cartilage first then shift to bone production sometime after. Some studies have shown that nicotine delays the shift to bone production. One study I read said that nicotine should be avoided for this reason for a least three weeks after orthopedic surgery. Other studies on smoking effects in general showed that smokers take 62% longer to heal broken bones than non-smokers.

I got back from my second post-op visit to the orthopedist yesterday. Before yesterday I was in a hard cast and put no weight at all on the injured leg. I am healing quickly and the doctor decided to skip the walking cast that usually comes next and had me fitted with a fabric and velco-strapped "boot". The fracture was barely visible on the X-rays. I'm now OK to put as much load on the leg as I can so long as I'm not feeling pain.

It pays to listen to your doctors and to respect what they tell you to do. I found my doctors to be very willing to listen and explain.

 

[Ryedan]

I got back from my second post-op visit to the orthopedist yesterday. Before yesterday I was in a hard cast and put no weight at all on the injured leg. I am healing quickly and the doctor decided to skip the walking cast that usually comes next and had me fitted with a fabric and velco-strapped "boot". The fracture was barely visible on the X-rays. I'm now OK to put as much load on the leg as I can so long as I'm not feeling pain.

In 1999 I broke my ankle, also both tib/fib but the ends at the ankle. yzer, I get the feeling your injury was higher up the leg, but I'm not sure. My surgeon used a plate on one side, a wire on the other and screwed them both back together. It looks really impressive on an x-ray . I was smoking a PAD of Export lights at the time and there was no suggestion that I stop smoking for a while so obviously I didn't.

This happened in the winter. After three weeks it was x-rayed. Going in for that x-ray I slipped on a wet floor in the hospital of all places and put full weight on the leg for a second. Nothing bad happened and was told the ankle was healing well. At five weeks after another x-ray my surgeon told me the bones had fully healed and that I could put full weight on it. That day the cast came off and no other cast or boot was put on. I did physio, recovered well and have not had any issues with it since.

Now I realize that everyone is different and there are also other factors involved, but it does make me wonder since our timelines are about the same just how much smoking really has to do with bone healing time.

And I'm not suggesting that people should not listen to their doctors. Just kinda thinking out loud here

 

[yzer]

In 1999 I broke my ankle, also both tib/fib but the ends at the ankle. yzer, I get the feeling your injury was higher up the leg, but I'm not sure. My surgeon used a plate on one side, a wire on the other and screwed them both back together. It looks really impressive on an x-ray . I was smoking a PAD of Export lights at the time and there was no suggestion that I stop smoking for a while so obviously I didn't.

This happened in the winter. After three weeks it was x-rayed. Going in for that x-ray I slipped on a wet floor in the hospital of all places and put full weight on the leg for a second. Nothing bad happened and was told the ankle was healing well. At five weeks after another x-ray my surgeon told me the bones had fully healed and that I could put full weight on it. That day the cast came off and no other cast or boot was put on. I did physio, recovered well and have not had any issues with it since.

Now I realize that everyone is different and there are also other factors involved, but it does make me wonder since our timelines are about the same just how much smoking really has to do with bone healing time.

Man, that was an adventure. My tibia broke a few inches above the ankle and ran diagonally up the bone for a few inches and all the way across. Yes, individual healing times vary and age makes a difference. I'm 60 and wouldn't heal as fast as if I was 20.

 

[Ryedan]

Man, that was an adventure. My tibia broke a few inches above the ankle and ran diagonally up the bone for a few inches and all the way across. Yes, individual healing times vary and age makes a difference. I'm 60 and wouldn't heal as fast as if I was 20.

Yup age affects it too I'm sure! I was 42 at the time. And who knows how long it would have taken to heal if I hadn't been smoking.

And yes, quite the adventure . Good to hear you're doing well

 

[Susaz]

Dammit, I should have picked up some zero nic juice for before this surgery tomorrow, but it never occurred to me they would tell me I couldn't vape at all. I even asked about a nic patch and they said "no nicotine of any kind". Is there any medical reason for that or are they just being Nazis about it?

Nicotine can cause clotting... Effects of Nicotine on Arteries | eHow

 

[Robino1]

We all know that the words "Smoking" and "Nicotine" were basically the same thing in a LOT of studies. It could very well be possible that "nicotine" was used in place of the term "smoking". Relatively speaking, "nicotine" use in the form of patches and gum (now ecigs too) is in its infancy. There is a part of me that knows that some in the medical community like to use a bit of the scare tactic to get smokers, and now nic users, to quit the use of these products.

I can see how smoking can possibly affect anesthesia. I have a harder time with nicotine affecting healing. I had a broken elbow while I was still smoking. It took almost exactly six weeks to heal. They said there might be stiffness or pain when I fly or when it rains. I have never had any problem in either of those cases. When my gall bladder was removed, I have minimal scarring and that was done when I was still a smoker also. I am one of those that um just couldn't give up the cigs pre or post surgery. I might have cut back......yeah, right. Never happened..... although I really tried.

 

[RichardV]

On October 31st I had a hernia repair done (not laproscopic), no one said anything about not vaping. The only mention of vaping was that I had to do a breathing treatment similar to asthmatics to open the airways that vaping may restrict. Also no mention was made about vaping after surgery.
In the 12 days since surgery I seem to be healing faster than some friends that had the same surgery, one of them was still limping with some pain 8 weeks later.

 

[MiamiMom63]

I broke my foot. Well, I sort of crushed my foot by landing on it while falling down my stairs. I sort of landed on the edge of it and made if fold inwards. Thus majorly crushing it and some bones. I was told that since I smoked for 30 years that I would heal slower, plus I had just started going through menopause. Plus I already suffer from high blood pressure and heart problems run in my family. It was a wake up call. Yes, vaping is safer than smoking but we still have to think about the nicotine. Not long ago since that time I ended up in the ER two nights in a row with blood pressure 204/126. Stroke possibility. Anyhow, from that point on I've worked on lowering my nic. I'm lucky to be able to not have a stroke and get my meds straightened out to lower my blood pressure. I now vape at 6 mg nic with a rebuildable, which helps me get the same satisfaction but at a lower nic level. Nic does affect us. We have to consider it with our medical issues.

 

[MiamiMom63]

Oh, and all women should take Calcium Supplements! I highly recommend that for our bones as ex-smokers! Smoking for many years affects your bones so you should take Calcium. Plus going through menopaus does the same.