Blood Tests Before Surgery

I've been asked a bit not about the blood tests I had done.   It seems that most Drs require pre-op blood tests. 

My local hospital were very familiar with the requirements so they seem to be a standard list - but do check they are the ones you need to have done, don't just use my list incase things change or your Dr has different requirements!

Hanse wanted the results of my bloodtest 10-14 days before surgery.  You can't have it done too far in advance as the results need to reflect your health when you have surgery.   They asked for:  Blood count

                    INR, PTT

                    Creatinin

                    Sodium, Potassium

                    ALG, GGT.

These tests measure things like how fast your blood clots to ensure you won't have a more of bleeding.  

You need to get the results printed out as Hanse need the numbers.   For example my APTT was just outside the normal range.  By having the numbers they were able to look at how slowly I might be clotting and decide if that would prevent my surgery going ahead.  

I would arrange the test for say 16-14 days before surgery as they take about a day (in my area) to analyse the samples and then you'll need the GP to review and print your results for you to collect.   

Shopping List for Liposuction for Lipoedema

This list is a starting point for things you might want when you are having liposuction for lipoedema. It is designed for you to print it out and amend it.

I based this list on some of my pre-surgery preparation posts and created it for the Facebook community at MY LIPOEDEMA  JOURNEY - FOR LADIES GLOBALLY.  I thought it would be good to post it here too, so that it is an open resource. Please tell me any feedback you have so I can improve my list.  

  The Facebook group I have referenced above contains details of surgery experiences from a range of international ladies and is the home of the comprehensive international list of Lipoedema Liposuction Doctors.  I am a frequent user of that group, not the owner of it!  

Item you might need	Why I recommend it/advice
Waterproof bed sheet.	A great one is Gokart from Ikea (you can order from Ikea or on eBay).  This one is comfortable to sleep on as it has a fabric top over the plastic.   You can also put “puppy pads” or other absorbent bed pads in your bed, but they can move as they are loose, so the waterproof sheet is more reassuring.
Puppy Pads/stay dry bed pads (absorbent pads)	These are large items (not sanitary towels) which you can put on a bed or chair.  You may be given some of these by your clinic.  I used them to stand on after a shower in the first day or two to avoid dripping red tinged fluid on the bathmat.  Used for either reassurance or absorption.  Pack of around 20 for £10 on Amazon
Extra dressings/plasters	These are larger than household plasters (plasters is a UK word).  For example 6cm x 7cm.  They are an absorbent pad covered with medical tape that is breathable and soft on skin.  Brands like Mepore are available for around £7 for 60 dressings on Amazon, or you can get them in a local chemist for around £0.20 each.  You will want to use something like this until your incisions are healed dry.  If you shower every day you will need to change them every day to get the wet pad off your skin as they are not waterproof.
Vinyl gloves	If a friend or partner is helping you change your dressings, until your incisions are closed it is good hygiene to have them wear gloves.
Medical tape	If you do leak quite a bit you may need to tape gauze or puppy pads over the outside of your dressings.  Some clinics will give you tape and gauze, so check before you buy.  If you buy tape, something like Durapore is around £2 a roll and is nicer than Micropore as it sticks well but comes off gently too. If you are sensitive to plasters then try the tape first before you go!
Shewee/Go girl/funnel	If you are having your thighs done then you may find it tender to sit on the loo.  You can use a funnel with open crotch compression to wee standing up without taking your garment down (or with pulling your compression down a bit).  From £1 to £10.
Rubber toilet seat ring.	Again inner thighs – an option for using on the loo instead of a funnel or for when you are not having a wee.  An air filled ring is still hard to sit on so I personally didn’t use it much as it was a core muscle workout and a bit distracting from going to the toilet! One that needs inflating with air (check if you need an adaptor – probably works with a bicycle pump as mine did)£10 on Amazon)
Painkillers	You may be given some from your clinic.  You will generally not need anything stronger than the ones that are sold without needing a Dr to give you a prescription.  In the UK purchasing a cheap packet of paracetamol and one of ibuprofen would be fine.  You may want to take painkillers 20 minutes before showering or changing your compression in the first few days after surgery.
Other tablets/products	You may like to take arnica tablets or other vitamins.  Check with your Dr before the surgery if you should start or stop taking anything like this.  Some people find they get itching as their skin heals.  A product like Piriton which is sold for allergies in the chemist may be helpful.   http://www.boots.com/en/Piriton-Allergy-Tablets-30-Tablets_11235/ around £4.
Moisturiser/skin care products	Wearing compression makes your skin dry, so you will want to moisturise.  Avoid the incisions until they are totally healed
Scar healing products	The incisions will leave most of us with small scars.  Once they are healed closed you can treat them.  Popular products are Gel to rub in: KeloCote is around £20 and Contractubex is around £8.  You can order them on eBay.  Some people use BioOil.  Contractubex is most popular in our group.  Contractubex also make overnight healing patches which you use at night (gel in the day only then).  These are not sold in the UK so you may want to ask your clinic to help you with a local pharmacy who can order them in for you if you have surgery overseas.  Or ask an EU group member to help you by posting them to you.
Rubber gloves with grip or gloves with silicone dots on them	You'll need to adjust your compression garment and I find these gloves from Lakeland (also available on Amazon) look cute and are helpful for grabbing wrinkles and pulling up or smoothing out bunching.  I always use gloves with my compression.  Light gardening gloves are also a good option.  Around £2-5
Flip flops/crocs/large slippers	Surgery on upper or lower legs means you can drip fluid on your feet.  Shoes you can slip on and off and rinse clean are great.  You will likely go to the operating theatre in your own footwear but their clothing so think about something easy to get on to walk back to your room/recovery area.  If you are having lower leg surgery you will usually need footwear around 1 size bigger than normal for your journey home/early days.  That will allow for your swelling and the compression and extra bandages etc.  If you need socks (especially if you had lower leg surgery!) get ones with very soft elastic at the top – often labelled as suitable for diabetics/diabetic socks.
Clothing	Loose tops, thick socks and baggy trousers.  Needed for coming home from the clinic and for lounging around at home.

MLD (Manual Lymphatic Drainage) and SLD (Self Lymphatic Drainage)

You'll need to find a therapist to give you manual lymphatic drainage massages (MLD) for around a month after surgery.  I'm going twice a week as recommended by Professor Schmeller and wish he'd recommended three times as it feels so good!

I went to see an MLD practitioner before surgery and had a couple of massages, to ensure I liked her and would want to have post surgery treatment with her.  I also figured having a well drained lymph system pre-surgery sounded a good idea, so I had one close to my trip to Hanse.

There are official qualifications in MLD.  Vodder training is most common in the UK I think (and the one that Professor Schmeller was happy my lady has).  Lymphatic specialists are DLT (decongestive lymphatic therapy) Members of the MLD UK body.  The MLD UK website has a page where you can find a local therapist and filter to Member DLT only.  

Professor Schmeller recommended I waited a week to settle before starting massages so I would book at least that date in with your therapist/check the notice they need to organise your appointments. 

My massages cost £55 each and last around 1 hour.  The therapist is paying particular attention to my bruises and I was amazed that in the first session she gave some effort to my big cannula bruise in my hand and it vanished very soon afterwards!  I think the MLD is really helping speed up my healing and it feels great :)

I also asked if she would teach me some SLD techniques as I was given a handout by St George's at my first NHS appointment with them and told that it is a good thing to do to yourself, but I feel it is hard to learn a self massage technique from a sheet of paper.  My therapist is happy to work through it with me so I become competent.  It might have been good to do that before going for surgery.  

Things to do before surgery

Because I had my consultation the day before surgery, my preparation was based on email exchanges with Hanse and my reading online. I hope having everything in one place might help someone:

Clothing

Work out your clothes for travelling/early days.  if you are having lower legs you might find your feet swell or are padded, so might need a larger size shoe/hard soled slipper.  

In the clinic you won't need to take a nightdress as you sleep in their garment (well I did!). Keeps your own clothes clean from leaks and as they gave me a clean garment at some point, it seemed that they expected me to stay in their garment and dressing gown.  I had spent ages combing shops for a suitable nightdress to wear there instead of my PJs!

I made sure I had a stash of baggy jogging trousers and tunic tops/loose nightdresses so I had no elastic or tight seams on my bruises.  

Surgery shopping

I made a list of the things I purchased.  I would also book a supermarket delivery or kind friend to get you fresh food and tasty meals when you get home.  I didn't want to go walking around the supermarket on my first day home and hub and I felt better about him being home with me instead of out shopping.  

MLD

Find your therapist, decide if you want a massage pre-surgery to see if you get on, and then book in your first session for the week after your surgery.  

Pre-surgery blood tests

Hanse will ask for a set of pre-surgery blood tests to be done.  If you aren't in Germany around 2 weeks before your surgery you'll need to get your GP or hospital consultant to organise these via the NHS or find a private provider like BUPA.  My experience of this was that it took some organising.

Home prep

Make the bed with your waterproof sheet before you leave to save an annoying job when you get back.  I had to find another duvet and get hub to change the bed the night we flew back.  That wasn't popular!  Also (if you share a bed with a partner) work out where they are sleeping for the first few nights so you can get all that bedding ready too.  I had got home before I realised I didn't want to risk leaking on my good cream bedding!   

Regular towels are likely to be fine - I got only a little drip of fluid on mine and was washing them regularly to keep down on transferring any infection from my morning showers.  

Think about where you are going to sit.  I put a blanket on the sofa with pads ready so I could collapse when I got home without worrying.  

My carpets and flooring were fine.  The only time I dripped anything like I did in the clinic was after a shower in the first two days, so if you don't want to risk staining your bath mat use another puppy/incontinence pad as a mat to get onto for drying yourself and changing your dressings.  I stood on these until I was sure I was clean.  

Packing/Travel plans 

I didn't consider eurostar, I guess it would be a very long journey to drive all the way. We booked flights to Hamburg then took the train to Lübeck.  You could hire a car, we just didn't plan on travelling outside the two cities and thought it seemed easier.  

Consider if you are taking carry on only or checking in a bag.  Because we managed to pack light and go carry on only, I had to ensure I was aware of the security rules on 100ml max size liquids.  This affected my toiletry packing.  

Pre-consultation blood tests

You'll need to have some blood tests done and send the results to Hanse-Klinik around 10-14 days before your surgery.  

I ended up being late sending my results as my first set of tests had some problems and I had to repeat them at the request of my GP surgery.  The results were available to my GP within 2 days but it took me a few days to get the information because they wanted me to speak to someone about my one abnormal result.  

You will either be able to get your GP to request these (the list is a fairly standard pre-operation set of blood tests) or have to find a private clinic such as BUPA, where I heard it can cost up to £200. If you have any care for your lipodema from a lymphodema nurse or consultant then they may be able to help you with getting the blood tests too. 

Make sure you sort out how you are getting these around a month in advance, to ensure you get the results in time.

I was lucky that because I had recommendations to have surgery at Hanse from my NHS consultant, I was able to get these blood tests done via my GP surgery, but I did have to put in some extra work to get the actual results printed out so I could scan them back in to send to Hanse.

Things you might need: supplies

The clinic gave me a big bag of dressings, injections, antibiotics etc to bring home, but there were a few other things I needed:

• Waterproof bed sheet.  The "puppy pads" the clinic gave me worked fine but because they are loose pads, they can move as you wriggle in your sleep.  The sheet I got was from Ikea and was called Gokart.  Ikea do home delivery, but I got one from Ebay for the same overall price.  I really didn't want to stain the bed so this made me feel a lot safer and has been comfortable to sleep on as it has a fabric top over the plastic.  
• Extra dressings.  I was changing my plasters each morning and night, and I used all the massive stash I was given by Hanse, and still was wet.  I ordered some more of the ones the clinic gave me from ebay, but I was able to get similar ones in the chemist for 20p each whilst I waited for my package to arrive.  
• Vinyl gloves.  These kept DH from transferring germs to my open wounds when we changed dressings.  Sadly his hands are bigger than mine so the gloves that fit me are tight on him!
• Painkillers.  I was given a strip of ibuprofen and paracetamol for the travel home.  I continued to take them for a few days or painful activities so it is worth ensuring you've got them in the house.  
• Rubber gloves with grip or gloves with silicone dots on them (if you are new to compression).  You'll need to adjust your compression garment and I find these gloves from Lakeland (also available on Amazon) look cute and are helpful for grabbing wrinkles and pulling up or smoothing out bunching.  
• Clothing.  loose tops, thick socks and baggy trousers.  Needed for coming home from the clinic and for lounging around at home.  As I didn't have my lower legs done I fitted into my regular shoes and slippers just fine.  
• Flip flops.  It was better to have those in the clinic for putting on and walking around after surgery instead of my fabric slippers as they could be rinsed clean if I got drips on them or splashed them.  They were easier than slippers to take on and off as I could just slide my feet in and out as I got in and out of bed. If the weather was warmer they'd have been sensible for wearing in transit,  but not in Germany at the start of March!

Things I got but didn't really need:

• Extra puppy pads/stay dry bed pads.  I got a bag from Amazon for around £10, which meant I was more relaxed about popping one on the floor to change my dressings, on the seat under me, fresh ones in bed etc.  It turned out that the clinic were right and they'd given me enough, but being able to throw them around the place was very reassuring in the first two days so I think the peace of mind was worth it.  
• Extra tape.  The clinic gave me two reels but I panicked when I'd used one sticking on lumps of gauze in the first few days.  As the tape was silky and so much nicer than papery tape, I ordered the same tape from ebay.. then the next day I was dry enough to go to plasters only.  Should have had more faith.  
• Shewee/Go girl.  I got one for around £10 then forgot to pack it.  The first night it would have really helped.  By the time I got home I could pull my garment down to use the loo, so it would have been in the first list if I didn't forget it
• Rubber toilet seat ring.  Again probably would have been great on surgery day as that was very painful to sit down.  I did use it for a few days at home (got a cheap one like a hot water bottle for around £10 on Amazon) but as it was filled with air I found it wobbled so was a good exercise for my core muscles to try and sit on it!  I gave it up within a day or so.  

Things you might need: EHIC & Travel Insurance

I agonised about travel insurance, then decided it sounded too hard to get insurance when I was going for a medical procedure, so I decided not to do anything risky in my free time and keep my fingers crossed I didn't fall and break something.

What I did do, was renew my EHIC or European Health Insurance Card.  That means you get treatment for the same price as a local.  There are dodgy links so to be sure I got to the right government page I went via MoneySavingExpert http://www.moneysavingexpert.com/travel/free-ehic-card, where you can also find out more about what an EHIC is.  There is an NHS page on German healthcare, if you want to check up in advance the details of what the EHIC provides.  

The form takes only a few minutes to fill out and the plastic card came within a week.

The EHIC doesn't affect the price Hanse charge, so they didn't need to know about it.

Arranging my consultation

When I contacted Hanse-Klinik the first date I was offered was about four to six months away.  Rather naively I had expected it would be really quick, but I think it helped me take more time to understand my lipodema and to get fit. (and to feel confident so many people want to see them).  

Aqua exercise is strongly recommended as it supports your joints and applies pressure to all the lymphatic system to promote lymphatic flow.  So, by the time surgery rolled round I'd done a couple of terms of pilates and found several different aqua exercise classes to fit into my week.  I've actually become a bit of a water exercise fan.  I'd never have imagined how I'd love it so much that I'd get up to exercise in the mornings regularly!

When I contacted Hanse I was asked to send some details, including the recommendation from Dr Gordon that I consider liposuction with them, and then having filled out my history I had to add some photos.  Taking them felt uncomfortable as I'm not in the habit of posing in my pants!  

Once they'd reviewed my photos the Professor advised me that he thought I needed one surgery in three locations: outer and inner thighs, and knees.  He gave me an indicative price (which was exactly the price they formally quoted and charged me when I saw them) and offered me the choice of either booking a visit to include a consultation and then surgery on the following date, or, just to go out for a consultation and then book surgery for a later date.  I was really rather shocked to be offered the joint visit, and probably should have had someone else read the email properly!  If I could have gone out to see him within a couple of weeks of the email exchange, that would have been perfect as I really was keen to meet in person.  However, I'm not very patient so the idea of waiting months to see him, then the same amount of months again for the surgery really didn't appeal.  

So, I made the reservation for the joint appointment and then worried... and emailed!  The Professor and the whole clinic team were really responsive about answering emails.  They have very good written English so it wasn't difficult to communicate.  I did use some of my schoolgirl German mixed with a bit of google translate, to be friendly, but not in crucial things I was saying incase I was mangling my translations!