Advising patients not to talk after colorectal surgery

[FiO2]

Do you advise patients against talking after colorectal surgery?

This may sound awkward, but in my country (Brazil) some surgeons tell patients not to talk after colorectal surgery, fearing talking would lead to abdominal distension. Never seen evidence supporting that recommendation, but people still do it.

I never really cared about that, but recently our president (yes, the president) was submitted to a colostomy reversal procedure and every press release said he was advised not to talk.
It’s all over the news if you guys happen to speak portuguese.

Four days after the procedure a parliament leader was elected and we were told the president wasn’t able to call and congratulate him because doctors insisted the president shouldn’t talk. One day after that, newspapers told he got scolded by doctors for having a 10-minute conference with a minister. As far as we know he is still being advised not to talk today, one week after the procedure.

Sorry if it’s a stupid question, but is it a thing where you practice or where you trained?

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[TraumaLlamaMD]

10/10. I’m going to start doing this from now on, it will make rounding on my patients in the morning a lot more pleasant!

If this is real - no, I’ve never heard of anything remotely like enforced silence after colorectal surgery.

 

[FiO2]

Believe me, it’s real (I wish everyone could understand the news in portuguese). It got to a point where our president doesn’t talk for a week and every major news media reports it as if it’s common sense not to talk after colorectal surgery.
I know how that may sound, but it’s real. That’s why I really need to see what you guys have to say about it.

 

[Psai]

When my patients start talking, that's when I push meds and put the tube in their vocal cords. It's generally before surgery though, not after.

 

[potential_fut_doc]

True or not true, Im using this on all my future patients. Gonna go find an obscure case report to back me up in case someone calls me out on this.

 

[doc05]

Sounds incredibly stupid.

 

[TraumaLlamaMD]

Believe me, it’s real (I wish everyone could understand the news in portuguese). It got to a point where our president doesn’t talk for a week and every major news media reports it as if it’s common sense not to talk after colorectal surgery.
I know how that may sound, but it’s real. That’s why I really need to see what you guys have to say about it.

From some of the photos I’ve seen, he had a nasogastric tube in for a while after surgery. I can see why it would be uncomfortable to hold a long conversation or appear in public that way. But I’ve certainly never heard that it increases distension.

 

[FiO2]

From some of the photos I’ve seen, he had a nasogastric tube in for a while after surgery. I can see why it would be uncomfortable to hold a long conversation or appear in public that way. But I’ve certainly never heard that it increases distension.

Nasogastric tube was placed yesterday. Apparently he’s got an ileus now. But he went the whole week without talking before that.

It’s not that he was uncomfortable talking. He’s been specifically told not to talk and even scolded because he had private conversations. The reason was it could cause abdominal distension. It’s on the news everyday.

When he vomited and got that nasogastric I even heard lay people say it happened because he didn’t follow the doctor’s instructions (he had that 10-minute conference with a minister the day before).

 

[TypeADissection]

If you look at the most recent article published in Journal of Opinions, "Enhanced postoperative recovery in patients when next of kin refrain from speech" shows that patients actually do the best when their friends and family don't talk to you after surgery either. P value < 0.001.

 

[FiO2]

True or not true, Im using this on all my future patients. Gonna go find an obscure case report to back me up in case someone calls me out on this.

If you look at the most recent article published in Journal of Opinions, "Enhanced postoperative recovery in patients when next of kin refrain from speech" shows that patients actually do the best when their friends and family don't talk to you after surgery either. P value < 0.001.

Please do not respond with sarcasm.

Sarcasm really doesn’t bother me, but think about my situation here.

I’ve been called an arrogant smartass who thinks he knows better than the president’s doctor for the past week. People send me newspaper headlines that “prove” I am wrong and laugh at what I say when I tell them it’s ok to talk after colorectal surgery.

Imagine the kinds of people I’ve been dealing with.
These people are not able to understand sarcasm. They would actually use your posts to prove me wrong.

 

[SLUser11]

Do you advise patients against talking after colorectal surgery?

Sorry if it’s a stupid question, but is it a thing where you practice or where you trained?

Sorry you've got this all wrong. We allow most of our patients to talk. When they have a low anastomosis, we simply request that they don't talk out of their @$s.

It can disrupt the staples....

 

[Winged Scapula]

You've got an attending academic pre-eminent colorectal surgeon above telling you, sarcastically, its BS.

Swallowing some air is normal with natural speech but it shouldn't be such great volumes that it causes clinically significant abdominal distention. I've never heard of restricting talking after abdominal surgery, but like others above, it could come in handy on am rounds.

I would ask what data supports this. Then again, with AP and Reuters reporting that the take down took 7 hours and that he had a "tube in his throat" for N/V and that he was staying for 10 days to "prevent infection", I'm not sure anything I'm reading about his procedure is correct or what the status of CR surgery is in Brazil because all of that sounds nuts to me.

 

[FiO2]

You've got an attending academic pre-eminent colorectal surgeon above telling you, sarcastically, its BS.

Swallowing some air is normal with natural speech but it shouldn't be such great volumes that it causes clinically significant abdominal distention. I've never heard of restricting talking after abdominal surgery, but like others above, it could come in handy on am rounds.

I would ask what data supports this. Then again, with AP and Reuters reporting that the take down took 7 hours and that he had a "tube in his throat" for N/V and that he was staying for 10 days to "prevent infection", I'm not sure anything I'm reading about his procedure is correct or what the status of CR surgery is in Brazil because all of that sounds nuts to me.

There’s never been data supporting this as far as I know. It’s just something a few (not all) old school surgeons do over here.
I have seen that kind of recommendation a few times before, although never for that much time after surgery (usually just for the first day... not that there’s evidence for that either). We just regard it as an old habit some surgeons don’t get rid of.

It may sound weird, but please don’t judge the whole country for it. For many doctors here it’s as shocking as it is for you. The thing is, it’s been kind of a big deal over here for the last few days (imagine having the president not talking for “no reason” for a week).

About those news you have seen, maybe translation issues made it sound worse than it really is:
He had a nasogastric placed after N/V apparently because of ileus.
He will be staying for extra days to treat infection, not to prevent infection (apparently he got an abdominal collection drained recently and it was considered infected).
It really was a 7-hour procedure, but many good doctors I know tell me the surgeon is very skilled (and all of them also laugh at the not talking thing just like you did), so I really don’t know what to think of it. Maybe a lot of adhesions?

I should also tell he had NPO and parenteral nutrition from day one (long before the vomiting started) and we got no reason for it in the news, but don’t get me started on that. It’s really the not talking thing I wanted to address here.

 

[HighPriest]

I’m just amazed you can get patients to follow through with this. I can’t get people to avoid talking after laryngeal surgery, where it’s common practice to avoid speech. We used to tell people 14 days of no speech, but now most of the guys I know ask for at least 72 hours simply because patients have zero compliance.

 

[Psai]

I’m just amazed you can get patients to follow through with this. I can’t get people to avoid talking after laryngeal surgery, where it’s common practice to avoid speech. We used to tell people 14 days of no speech, but now most of the guys I know ask for at least 72 hours simply because patients have zero compliance.

Buzz their recurrent laryngeal

 

[FiO2]

I’m just amazed you can get patients to follow through with this. I can’t get people to avoid talking after laryngeal surgery, where it’s common practice to avoid speech. We used to tell people 14 days of no speech, but now most of the guys I know ask for at least 72 hours simply because patients have zero compliance.

I don’t know if they follow through for days.

The times I’ve seen people who were told not to talk after abdominal surgery were all just for the day after the procedure (and yes, each time I told them it was not necessary).

They are usually very compliant to the not talking thing. Even when I tell them there is no reason not to talk, most of them prefer not to talk “just in case”.
But that is just for one day. I don’t remember seeing someone who was told not to talk for longer than that.

Our president’s surgery was the first time I’ve ever heard of not talking for a week after abdominal surgery. I don’t know why they stretched it for so long.
The procedure was performed last monday and to this day he is still advised not to talk. He is running the nation with his mouth shut for a week (I can see why it sounds like a joke).


Your feedback is important. Please, even if you think it’s stupid or hard to believe, just tell me what you think about it.

 

[DokterMom]

It may sound weird, but please don’t judge the whole country for it. For many doctors here it’s as shocking as it is for you. The thing is, it’s been kind of a big deal over here for the last few days (imagine having the president not talking for “no reason” for a week).

Me, imagining our president not talking for a week...

 

[TraumaLlamaMD]

Me, imagining our president not talking for a week...

“No tweeting after surgery, it contributes to energy loss and electrolyte dysregulation”

 

[OrthoTraumaMD]

I’m just happy my patients don’t talk at all, thanks to anesthesia.

 

[deleted745951]

“No tweeting after surgery, it contributes to energy loss and electrolyte dysregulation”

FAKE NEWS.

 

[evilbooyaa]

I’m just happy my patients don’t talk at all, thanks to anesthesia.

A surgeon thanking anesthesia on the internet? The world is ending, @Psai

 

[OrthoTraumaMD]

A surgeon thanking anesthesia on the internet? The world is ending, @Psai

Well it’s either that or I hit my patients on the head with a hammer to knock them out...

 

[HighPriest]

Well it’s either that or I hit my patients on the head with a hammer to knock them out...

That’s what I prefer. It’s natural anesthesia. All those drugs are bad for you and they don’t do anything anyway. It’s just big pharma holding you hostage.

 

[OrthoTraumaMD]

That’s what I prefer. It’s natural anesthesia. All those drugs are bad for you and they don’t do anything anyway. It’s just big pharma holding you hostage.

In my defense I’m not always the “nice” surgeon. I routinely make fun of anesthesia because they don’t know how most of their drugs work. (By their own admission.) At least my hammers and screws are easy to understand.

 

[Psai]

A surgeon thanking anesthesia on the internet? The world is ending, @Psai

yeah i know, I'm debating about whether to hang it up now since hell has to be freezing over or something

Well it’s either that or I hit my patients on the head with a hammer to knock them out...

I thought the cavesurgeon was an orthopedist because of the tool in his hand until I noticed that there's no device rep in the room

 

[FiO2]

Well, from the answers I got so far I think it is safe to say none of you has ever even heard of telling patients not to talk after abdominal surgery. And I guess none of you thinks it makes sense. Right?

Now please tell me what you honestly think about the situation (our president being told not to talk for a week after abdominal surgery).

Please be honest. I won’t get offended. So far I’ve seen “incredibly stupid “ and that’s the kind of honesty I’m looking for. If you don’t mind, add your status to the statement.

I know it may look like I am pushing a nonsense conversation, but it’s a real nonsense situation for us over here.

 

[HighPriest]

In my defense I’m not always the “nice” surgeon. I routinely make fun of anesthesia because they don’t know how most of their drugs work. (By their own admission.) At least my hammers and screws are easy to understand.

I know lots of people who don't know how a hammer works.

 

[HighPriest]

Well, from the answers I got so far I think it is safe to say none of you has ever even heard of telling patients not to talk after abdominal surgery. And I guess none of you thinks it makes sense. Right?

Now please tell me what you honestly think about the situation (our president being told not to talk for a week after abdominal surgery).

Please be honest. I won’t get offended. So far I’ve seen “incredibly stupid “ and that’s the kind of honesty I’m looking for. If you don’t mind, add your status to the statement.

I know it may look like I am pushing a nonsense conversation, but it’s a real nonsense situation for us over here.

I don't want to speak out of turn, but I think the general consensus you're getting here is that no one seems to think it makes sense.

 

[Jolie South]

I don't want to speak out of turn, but I think the general consensus you're getting here is that no one seems to think it makes sense.

THIS. It is straight looney toons.

 

[FiO2]

I don't want to speak out of turn, but I think the general consensus you're getting here is that no one seems to think it makes sense.

I just want it to be absolutely clear, beyond any doubt, that no one in this big forum full of experts believes it makes sense.
Comments that show how much it doesn’t make sense, like “it is straight Looney Tunes” are more than welcome, by the way.

Imagine being where I am now, trying to convince people that it’s ok to talk after colorectal surgery and being surrounded by people who believe talking after abdominal surgery is harmful just because “the president’s doc told him not to talk after surgery”.

 

[Psai]

If someone didn't believe something I told them, showing them posts by randoms in an internet forum from a different country wouldn't exactly be my first avenue of attack

 

[HighPriest]

Although: please let us know if you are able to cause a dogmatic shift in Brazilian colorectal surgery based upon this thread. I think we all deserve to be on that paper. I want to fly down and bask in the look of failure in your president's surgeon's eyes.

 

[FiO2]

If someone didn't believe something I told them, showing them posts by randoms in an internet forum from a different country wouldn't exactly be my first avenue of attack

Well it wasn’t the first... but how do you prove something isn’t a real thing? There are no data and no specific recommendations against every little “stupid” thing people do. Nowhere else people would just write “oh, and in case you ever think about telling patients not to talk for a week after abdominal surgery, just don’t do it, it’s stupid”.

I just told people nobody does this anywhere else in the world and the internet was the obvious way to go. This is the only (well, the first...) place I found where some people should be verified experts and would answer that kind of question. Couldn’t just ask random people, I had to go to random specialists.

Although: please let us know if you are able to cause a dogmatic shift in Brazilian colorectal surgery based upon this thread. I think we all deserve to be on that paper. I want to fly down and bask in the look of failure in your president's surgeon's eyes.

Not trying to change the bizarre practices in my country. It was just enough to win some bets.

 

[LucidSplash]

It’s crazy.

But I also know surgeons in the USA who still tell patients with diverticulosis/diverticulitis not to eat seeds or nuts or popcorn. “Especially sharp seeds like sunflower seeds.” And can’t be convinced otherwise by data.

Sometimes it takes generations for nonsense to go the way of the dodo.

 

[Trauma Surgeon]

I surely will practice this in my addict "entitled" trauma patients who complain all the time about the pain medication not being adjusted well enough

 

[HighPriest]

Sometimes it takes generations for nonsense to go the way of the dodo.

Like people who still say "sonometer."

 

[OrthoTraumaMD]

Like people who still say "sonometer."

Oh my god I hear that at conferences of the time and I want to punch them.

 

[HighPriest]

Oh my god I hear that at conferences of the time and I want to punch them.

They’d put you in jail for a sontury.

 

[nimbus]

I hope not talking becomes a worldwide trend.

 

[Psai]

We should have just went along with the original premise and pretended like it was a normal thing we do routinely.

 

[HighPriest]

We should have just went along with the original premise and pretended like it was a normal thing we do routinely.

Saw a man literally explode once after an uncomplicated colectomy simply because he couldn’t get off the phone with his girlfriend.

 

[VincentAdultman]

This may sound awkward

 

[Donald Juan]

Well, from the answers I got so far I think it is safe to say none of you has ever even heard of telling patients not to talk after abdominal surgery. And I guess none of you thinks it makes sense. Right?

Now please tell me what you honestly think about the situation (our president being told not to talk for a week after abdominal surgery).

Please be honest. I won’t get offended. So far I’ve seen “incredibly stupid “ and that’s the kind of honesty I’m looking for. If you don’t mind, add your status to the statement.

I know it may look like I am pushing a nonsense conversation, but it’s a real nonsense situation for us over here.

While I think it is a dumb thing that I have never heard of, I'm also not surprised that the surgeon taking care of the president is being as overly cautious as possible (even if it's wrong). I'm sure the president gets some antibiotics every time they have a cold as well.