BHR risks of the very thin patient

July 13, 2008

Aside from the challenges of being skinny, my surgery and recovery have been
very successful. The X-rays at 6 weeks looked fabulous, the doctor team has been
accessible by telephone, and at 8 weeks I am swimming, riding bike, and walking
nearly free of a limp.

I’m a very skinny person.  My body fat is in the less than 2%
range, so hard to measure
exactly.  I know many people envy such a condition but it is just the way I was born.  For
the benefit of other thin people anticipating BHR, I’d like you to
know there are potential
complications.

1.) Damage from surgical clamps

One day post-op, after the epidural was removed, I noticed the skin
on the anterior thigh
was numb.  The surgeon and his assistant speculated that the clamps normally used to
stabilize the pelvis during surgery don’t have much padding.  Since I had so little padding,
they probably damaged the subcutaneous femoral nerve.  Two days later the numbness
had vanished, so no big deal.  But if I were a thin patient I would advise the surgeon to add
some padding to that clamp for me!

2.) No place to inject the Lovenox

For 1 week post-op, one must self-administer anticoagulant
injections into thesubcutaneous fat, usually in one’s “love handles” on the side of the abdomen.  The drug is
absorbed into the fatty tissues.  With only a millimeter of subcutaneous fat, I struggled to
get the full injection under the skin.  It would usually produce a bulge under the skin that
would subsequently disperse over a period of about 20 minutes.  I don’t know of a
solution for this, but be prepared for the challenge!

3.) Food post-surgery

Because one must fast for 12 hours before surgery, and the hospital will likely offer little
or no food for 12 hours post surgery, a thin person can feel pretty
famished.  I
recommend you bring snack foods to the hospital and put them in
easy reach so you can
eat whenever you need to.  The nursing staff at Stanford Hospital had only milk and apple
juice on hand.  I think it is bad to be hungry at any time during recovery.

4.) Weight loss

I lost 5 pounds following surgery, and today, six weeks post-op, I’m still trying to gain it
back.  I suppose most of the weight loss is muscle atrophy, and I
know I will gain it
eventually.  I just want to stress it is so important to have lots of good food on hand and
easily had, especially if you are largely on your own after returning home from hospital.
Smoothies always taste good, and are easy to make if you have the stuff on hand.
Sometimes it is tough to cook when you are hungry and tired and
doped up, too.

Brian
R-BHR 6/28/08
Dr. John Lannin