Tuesday, August 2, 2011

PONV? Post-operative Nausea and Vomiting

PONV, Post-operative nausea and vomiting. First off ...while I loathe the condition ...I do like the acronym. :)

The following is a quote from an article I read in an online Out Patient Surgery magazine I subscribe to: "Previous studies had established family history as a risk factor, but this study is among the first to analyze a possible connection between PONV and such genetic factors as a family history of the condition, as well as motion sickness, migraine headaches and other adverse side effects of anesthesia." HERE is the link to the rest of the article.

UGH! Unfortunately, I have experienced that at least a few times and having done so ...would do ANYTHING not to ever endure that again. ANYTHING, I tell you! My family would agree, because the last experience with me at home in that state was stressful for them as well.

I am unaware of any other family members experiencing PONV, but then I can't think of anyone who has even darkened the door of an OR in my family, but for a couple of times. I seemed to have made up for that though ...and then some. Fortunately for me, nothing major. Hopefully, my sons don't take after me in this area.

I find it interesting that there may be a connection to motion sickness and migraine headaches. I have experienced both in my past. Motion sickness as a child and on rare occasion as an adult when I am not the driver, particularly in the back seat. And I have had a few migraines in my life, but not since November 2006 and historically, not that many.

I do recall, that the last few times I felt ill post-op, it began on the drive home. I left the hospital feeling footloose and fancy free and a few miles out, began to feel quite ill and I instinctively closed my eyes so as not to see the scenery passing by ...that motion thing and all. Unfortunately ...once that was set in motion ...I was doomed to POHOEAH (post-operative hell on earth at home) or PONVHOEAH (Post-operative nausea and vomiting hell on earth at home). Okay ...PONV at home ...PONVAH. ;)

Those seriously bad experiences have caused me to stress about it happening again prior to going into the OR. I've read that fear of PONV is a significant patient concern prior to going into surgery. I was relieved to read that I was not the only one with the concern.

Fortunately, since I have begun speaking up about just how ill I have been in the past, due to the post-op anesthesia effect, I have not been that ill since May, 2004. Maybe just a twinge of nausea here and there, but nothing remarkable ...THANK GOD!

I think part of the reason I have avoided PONV, is that since then, I communicated my concerns (abject FEAR) to the physicians involved (gas doc and surgeon). Preventative and post-op measures were taken so that PONV would hopefully not be an issue and it was not.

PONV was such an awful experience, that not only did I tell my docs ...I told housekeeping, dietary, maintenance, nursing, volunteers, roommates ...and their doctors ... and all visitors ...and administration ...and if I could've gotten a hold of the PA system ...would've just made a general announcement throughout the hospital ... AND skywriting above the hospital for all who entered that day was a consideration. I'm just saying. ;)

I don't know what they did regarding what drugs were given, but I do know they always put the antiemetic patch on my neck. I used to have this mantra in which I said "Please don't give me morphine because it makes me vomit incessantly for hours." But, then after a few years, I found out it was the kidney stone and not the morphine that caused me to be so ill. So, the PONV I had previously experienced was caused by some other drug(s). ?

I was particularly impressed one day after I woke up in the OR, not post-op ...the OR,stating how great I felt and couldn't believe I was so awake and alert after a urology procedure for a small ureteral stent placement. The anesthesiologist had listened to me (June 2004) describe the PONV horror that I had endured at home previously. And so he proudly informed me (while still in the OR) that he gave me minimal medication and I believe used Toradol as one of them. It was the only time in post-op ...ever ...that I woke up alert and ready to go home ...from the OR table to out the door. I did have post-op ureteral stent discomfort though, from being worked on. The nurses were surprised I was back in my room so quickly and that I wanted to do everything I had to do before being discharged, sooner than they wanted me to and independently of their assistance. But, I did and then went home ...uneventfully. There was one other time I went home uneventfully, although I don't know what the difference was.

Thankfully, all Docs involved have listened carefully, but since I stayed overnight ...I don't know if the hospital experience would've been as positive as the one I just described had I gone home the same day. That was an unusual experience. I had a few years in which I definitely was having a rough patch in my life and I earned my frequent flier OR status. I am HAPPY to report that is not the case now. Ha! No pun intended. :)

The most recent SDS OR experiences involved a surgical center in which I also had very positive post-op experiences. As a matter of fact, I highly recommend a surgery center experience over going to a hospital, if you are a candidate to do so. But, that is a post for another day.

When I was a newbie to the OR (2 C-sections, 2 meniscal repairs) no one ever asked me about having any side effects from anesthesia and so I just went in never realizing there was a possibility they could tweak the meds, etc., to help me avoid PONV. I have since noticed that the anesthesiologists do ask now. And as I stated previously ...I also speak up.

The surgery center I have been to inquires about anesthesia side effect history on their registration form and then is followed up by the anesthesiologist in pre-op. Excellent idea!

I would advise anyone with a history of PONV going in for surgery to discuss their past experiences with their physicians (surgeon and anesthesiologist). If you are not comfortable speaking up, have someone else advocate your concerns for you.

If on the ride home, you begin to feel the least bit ill ...close your eyes until the car stops, so that the motion doesn't increase the nausea.

Call your physician if the PONV is bad and they can call in an antiemetic suppository if they think it is necessary.



Chrysalis Angel said...

That IS the pits. I'm one of those that has a heck of a time with anesthesia. They have found the right combo to help me with it, thankfully!!!!

I can't take pain medication either. What the heck? My docs can rest assured there will be no "seeking" from me.

SeaSpray said...

We're kindred spirits again. :)

Yes ...I know for sure the surgery ctr has the right combo and perhaps hospital does too. God forbid, but if I am ever in SDS again for anything at hospital, I will find out when I go home.

i thought it was interesting on the video in which he said certain surgeries may be more prone to being a factor in it.

Vicodin gives me nausea and intestinal rxn. thankfully percocet works well or I would've been up that proverbial creek without a paddle when stented.

The morphine is what they give you for kidney stones where I went and a nurse told me the morphine was causing me to vomit and so for about 4 years I pleaded ..no morphine, etc. Then my doc decided to test it out when i didn't have a stone and I did not get sick. But about 18hrs later in the wee hrs of the morning I began itching so bad I actually thought I picked up scabies in the OR. I never had scabies and of course it wouldn't happen in the oR, but it was around 2am and the itch was so intense everywhere and I do mean everywhere that is what came to mind and I was soooo relieved to hear the nurse said it was the morphine. So I could handle it briefly, although another nurse told me that I could react sooner and worse.

But on this video, they do indicate it can cause vomiting. It was given to me as a pain med when in my room and so perhaps in the or as part of anesthesia it would still have a bad effect with nausea. Moot point now.

I really don't know anyone else that has gotten sick from anesthesia except you. I wonder how much of the population is affected by it.

Thanks for your input. Good to see you! :)