My Cancer Surgery While on GLP-1s

I had my Stage 2 Malignant Melanoma surgery on March 3, 2025. It’s taken awhile to write this out, but I’m finally finishing it. I had two patches of cancer that needed to be removed; one on my left clavicle and the other on my right upper thigh. It went really well! I want to share some of the aspects of the surgery experience that specifically relate to my being on GLP-1s.

Pre-Op Anti-Solid-Food Preparation

The information about pre-op procedures with those of us on GLP-1s changes almost weekly. First, we have to be off the meds for a week. Then new info came out saying it wasn’t necessary to be off the medications at all. And once again, it is off our meds, this time for 14 days! These guidelines are for planned surgeries. In an emergency, they assume we have just eaten and take a different tact depending on the anesthesiologist.

The reasoning behind extended time off the meds is because, on GLP-1s, our digestion is delayed and we could possibly aspirate our own stomach contents (by vomiting) if there is still food in our stomachs. The vomit can then be inhaled, hence the aspiration. Then it can turn into aspiration pneumonia. About 30% of people who get aspiration pneumonia die. It’s a pretty serious issue to be aware of.

I chose to be off the Mounjaro for 11 days before surgery. Because of the frequent changes in protocol for someone going under anesthesia, I decided to remove my Mounjaro to inbetween the ongoing recommendations; between 7 and 14 days. I did this because I wanted to be absolutely sure I had nothing in my stomach to inhale. My surgeon said 7 days. I still did more.

I was also told that, because I was on GLP-1s, I needed to be on clear liquids for two days pre-op. Because I had done this for my colonoscopy last year, I knew I could do it without it being a difficult. Even when we are off the meds for a week, that only creates a half-life, meaning the GLP-1s are still in our system. In fact, it takes about 30 days for the medication to completely leave our system once we are off our shots.

Light Foods First

When I had the colonoscopy, I was told to eat a diet of light foods, aka soft foods, before I went on the clear liquid diet. Soft foods focus on the elimination of fibrous or pulpy foods; citrus fruits, anything with nuts, seeds, or chunks in it, tough meat, hot dogs, and raw vegetables.

I decided to do this again for this surgery even though I did not have to. Prevention is really important to me. Can you tell?

My soft foods were mostly yogurt, canned peaches, Chicken and Stars soup, and applesauce. You’d think my blood glucose would have soared with this diet, but I was still walking several miles a day and going to the gym, so they were fine. I knew I wasn’t going to be able to walk far or go to the gym for a couple of weeks after surgery, so I wanted to get that in.

Clear Liquids

I did stick to the clear liquids for two days pre-op. But I didn’t want to drink the typical apple juice, ginger ale, and broth. And nothing could be purple. orange, or red, which limited things considerably.

After I had my RNY Gastric Bypass in 2001, we were told to drink protein. Then, we didn’t know quite how important protein was in our diet. Today we know it is crucial. I didn’t want to go two days without protein, so I revisited the clear protein drink I drank after the RNY: Isopure. Of course, I looked on Amazon, but they only had the purple, red, and blue, so I had to look locally because I knew Isopure came in lemonade. I found it at a The Vitamin Shoppe across town, called them and they had one case. I bought it over the phone and they put my name on it. I was so happy to have the Isopure because I like the taste… Kool-Aid-y, but not as sweet. Isopure does have powder, too, much less expensive than the ready-made drinks, but I wanted things as simple as possible. Plus, the powder doesn’t dissolve really well. The Isopure was a welcome change from just the protein shakes. I will incorporate it into my daily protein supplement as an adjunct to food, but not the powder. It’s expensive, more than the shakes, but also more protein, 32 grams of protein per 11 ounces, which is the same size as the Premier Protein which only has 30 grams per 11 ounces.

Staying on the protein train, when choosing broth, I chose Chicken Bone Broth, with 8 grams per serving. Every gram counts! Regular chicken broth has less than 2 grams a serving. When I finished the chicken broth, I picked up some vegetable bone broth, same 8 grams per serving, and it tasted a whole lot better than the chicken. Not sure what vegetable the bones come from, but… didn’t ponder it too long.

That MIO orange-tangerine dribble stuff (above photo) is put in water. It was vile. It tasted like Tang and I think that’s disgusting. I tossed it. I also drank my usual Propel electrolytes (powder in water) even though it was grape. I poured some water with the grape powder onto a white washcloth and it didn’t show any purple, so I drank it. I had a few Pedialytes left, too, so added those to a couple of my 40 oz. tumbler. Pedialyte is a lot more expensive than Propel, so I only buy Propel now.

Water Only Time

I was told I could drink clear water until 4 hours before surgery, but I chose to drink only water for 12 hours before and NPO (nothing by mouth) for 8 hours pre-op.

How Did I Do?

I did well considering it all. The surgery went well and I had nothing in my stomach. I was happy about that. While I was not starving pre-op, when I was okay’d to eat post-op, I had picked out a new item for me to try; the Skippy Oatmeal Protein Pie. Was it ever good!

While it is 320 calories a cookie, I had not eaten in days, so splurged. Actually, I had two of them! I slept the rest of the day, so it was fine. See the saltines in the picture above? What would you choose? The saltines? Or the oatmeal yummy. I never have post-op nausea, so the yummy treat was my choice.

Memorize This Name: Exparel

I learned about Exparel from wandering the Internet when looking for non-opiod post-surgical pain relief. I am 14 years clean from Percocet and Norco. I became addicted after having foot surgery in 2008 and it accelerated terribly. I allow opiates in the hospital if they are in my IV. I tell them they can give me anything they want… as long as they don’t get in my hands, giving me control over their administration. I refuse opiate prescriptions or filled meds because I would take all of them before I left the parking lot.

When I had the malignant melanoma on my right upper arm, it was a more extensive surgery than expected. I ended up with a 10 x 5 inch incision and meditated for pain relief. I did really well with occasional ibuprofen, but because of the Chronic Kidney Disorder, I’m not supposed to take any of that.

Planning for two surgery sites on opposite sides of my body, I wanted to see if there was something new out there and found Exparel.

Exparel is bupivacaine liposome and is a local anesthetic that’s injected into the surgical site during surgery. That stuff is the BOMB! It lasts around the incision for about 72 hours. I learned they are also using it during OB/GYN surgeries, including cesareans. What a boon to newly postpartum women to not be in excruciating pain post-cesarean. Also, it will allow women to get up out of bed quickly and walk, thus avoiding the tendency to get blood clots. While, as a retired midwife, I think about cesareans, imagine having virtually no pain post-op for knee replacements, spine surgery, or surgically repairing broken bones. They are also using it in dental surgery. Just wow!

On the way home, I was feeling my right knee and it was numb. I was confused at first… plus was loopy from the anesthesia… but soon realized that was the Exparel. Where I had surgery on my thigh, I was numb from my hip to my knee. On my clavicle incision, I was numb from shoulder to lower rib. Amazing to not be in major pain post-op!

The Exparel lasted the three days as promised. It wore off slowly, but I continued having virtually zero pain post-op. I didn’t have to take any ibuprofen at all and didn’t even have to meditate for pain relief.

My incisions were not bandaged, but they just used Dermabond, a surgical glue. That was great, too, because it lasted for a couple of weeks, even with showers.

Reception of my Weight Loss/Health
Gain at the Hospital

I had my second cancer surgery in 2020. During that surgery, I had to be turned over to get to the area on my back that needed to be removed. I weighed about 380 lbs. and, as they were lifting to turn me, I was almost dropped. I woke up with bruises from fingers and a split under my breast.

Story and more pics in this blog post: Pre-GLP-1s: What it’s like to live over 300 lbs. I was excited to be having surgery weighing 127 (the morning of surgery). It’s such a delight to jump on the scale now after decades of despising it.

Of course I bragged about my Mounjaro excursion to the wonderful nurses and doctors I saw. Inside my head, I thought, “They could turn me over easily now!” And that felt good. They did not need to turn me over that time, but this new one coming up, they will. I am not scared to be dropped anymore.

I met two nurses on Mounjaro, too. One was a tiny Asian woman with Type 2 Diabetes. Asians, from all locales, including South Asia, have a higher percentage of Type 2 Diabetes than non-Hispanic white Americans. In fact, their average BMI for an Asian with Type 2 Diabetes is 23 or above whereas for non-Hispanic white Americans is 27.3.

Because many of us are loathe to use the BMI, there are the other criteria used for Asians to determine what is considered obesity.

BMI ≥ 23 kg/m2; obesity as BMI ≥ 25 kg/m2, and central obesity as BMI ≥ 90 cm in males and ≥ 80 cm in females.

When the grandfatherly anesthesiologist came to talk to me, we chatted about the ever-changing landscape of GLP-1s and anesthesia.  He said that, as far as he was concerned, it is all merely opinon and it will remain so for another couple of years. He said it will take one death and people will be more compliant with abstaining from the medication and food as they are being asked. He said if people understood the consequences, they would be more compliant with the rules. He said it is frustrating to have to cancel surgeries because of non-compliance. He was sweet as could be, offering his time to share his thoughts with me. I thanked him lots for talking with me.

I let him know that I am more than compliant, adding days to the requirements and he thanked me for that. “You will be safer for it,” he said. That made me smile.

Queen of the Operating Room

I always ask for specific music to be played in the OR. While many believe they are completely absent in their minds and bodies during surgery, I believe my spirit is still conscious and I want things to be pleasant and kind. I always ask that people be respectful of my body. Before, it was because of my weight. Now, it’s because of my skin. I was reassured they would be, and later, reassured that they were.

This go-round, I asked for my beloved Queen to be played and I was told they did. Previously, I have always remembered being wheeled into the operating room, but this time, when I received the Versed, I was gone! I had no memory from the injection of the Versed to when I woke up in the post-op bay. I don’t remember the surgeon coming to talk to me, either, which was really weird. At my post-op check-up ten days later, he reassured me that he did come and talk to me and told me everything went great. I knew he had to have, but was glad to have the reassurance. 

Apparently, weight can have a lot to do with how medication acts on a person’s body. My massive weight loss, once again, allowed Versed to do its thing. For many different surgeries and procedures, I was lucid until the general anesthesia was administered.

Mounjaro Again

I took my next 15mg. Mounjaro the day after surgery. I slept through that first day and, while I thought of it, didn’t have enough gumption to give myself the shot. I remembered the next morning and got that Mounjaro right back into my system.

Next Surgery Imminent

As soon as this surgery was finished, I had another Dermatologist appointment with two more biopsies done. Both came up positive. Not Stage 2 this time, thank goodness, but both needed to be removed. As did another one the Dermatologist neglected to tell me needed to be removed in the March 3 surgery. I am waiting for this next surgery appointment. I swear, I feel like Swiss cheese at this point!

I’ll let you know how that one goes once it is finished.