In the previous blog, we talked about our Dutch healthcare system.
Another system that was implemented fairly recently and of which it is said to be international, is called ERAS. ERAS stands for: Enhanced Recovery After Surgery and it is most commonly used in case of abdominal surgery.
ERAS has four pillars:
1.The smallest incision possible This means less tissue dammage and therefore faster healing.
2. The shortest period of food retention possible, because food retention leads to (feelings) of weakness.
3. The shortest period of bedrest possible. A survey concluded that four days of bedrest will cost you 15 years. What a shocker! Plus: not moving around will deminish muscle tissue and this process goes way quicker as you might think.
4. Good painmanagement. When constantly in pain, you won’t feel invited to move and keep up your strength.
The ERAS-plan is as follows:
Recovery starts straight after the operation, as soon as you are back of the ward. You are offered clear liquids, drink food and they will get you up.
First day post-op, you will have a bubbling and gurgling tummy, you will start farting and when you are able to drink 1,5 litre by yourself, the IV and the catheter come out. If you are not nauseated, you will be offered a bread meal.
Second day post-op, you will be pooping on the toilet, you will be able to wash yourself without any help, you can walk and you are on oral painkillers.
Third day post-op, you can go home. You don’t need help, besides help from your partner and/or family. Doesn’t that sound wonderful?
My reality with ERAS was slightly different though. When I was informed about ERAS pre-op, it caused extra pressure in me to having to live up to the ERAS-expectation and I was already stressed…
When I got back to the ward after my sigmoid/fistula resection, I was totally out of it and I was not able to get up by any means. I was able to drink clear liquids up to the point where my belly was starting to swell. I looked like 10 months pregnant. This is called a bowel obstruction. This was because I was drinking clear liquids and my bowels were not fully awake yet. Anyway, this was the point where the NG-tube had to be put in. What a most unpleasant experience that was! A NG-tube goes up the nose, down the back of the throat, into the stomach where it collects the bile. Normally the bile travels from the stomach to the intestines, but this is not possible when the intestines are not fully awake yet. So, the bile is coming out through the NG-tube. When you have a NG-tube, you are ‘nailed by mouth’ which means no food, no drinks. After a day or so, my belly went down a little. The NG-tube came out and recovery could go on with a delay. Some three days post-op, my tummy started gurgling and I was able to fart and shart as well to my great dismay. As soon as the NG-tube came out, I was allowed to drink and eat a little soft food. Day 5 post-op, I was released to go home. Since I live alone and having no family nearby, this was quite a challenge…Thank God for my neighbours: one put my walker together, one was taking care of the trash. And then there was Picnic, an online groceryshop that brought my groceries INTO the kitchen. Such a great help!
Now, is ERAS also implemented in your country? Are you familiar with ERAS? What are your thoughts about this?
January 2019
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