Friday, June 8, 2012

All You Never Wanted to Know...

As you all know I had my surgery last Wednesday, 5/30 and This is the low-down of how things went to the best of my recollection, and discharge summary.
Don't worry-I'm not going to write a minute by minute replay. Heck, there are hours and perhaps even a day or so that I just can't remember due to the lingering effects of anesthesia combined with pain meds.
But here goes.

After signing on the dotted line down in admissions, I was taken to pre-op where I got undressed, donned my johnny and got into bed.
Dave is with me and my surgeon Dr. S comes by to say hello and I also met Dr. D. who will assist her.
In fact I meet lots of people and sign many forms.

An IV is placed and I am given my 5 minute warning before the OR.
Dave and I kiss goodbye and he goes to the waiting area on the floor below.
I recall my nurse saying that I will now receive some medicine through my line that will relax me. It is approximately 10:30am.

The next thing I know someone is saying "She is awake"
I fight to open my eyes but they are so heavy. I ask if "we are all done?" and am told yes.
I ask for Dave and they tell me they are getting him.
I see Dave. I ask the time and he tells me it is 3:18pm
I sleep.

I awake in what will now be my room for my hospital stay. Again I meet new faces.
I spend the rest of the day and part of the night in a sort of hazy sleep. After awhile I begin to be more aware of things.
I note that I have a morphine PCA for pain control. I also have an ng tube and a foley catheter.
There is a drain attached to my lower left quadrant. There is a large, bulky dressing covering my mid section.
I am also receiving IV fluids for hydration as I continue to be npo.

(I'd like to apologize to my sister who called me that evening-I haven't a clue what either of us said. :)

Day one post-op
My foley is removed and I am assisted up into a chair. I am given ice chips only.
After about 45 minutes I have had all I can tolerate and I return to bed.
All through the time since I came to this floor my vitals are being monitored and my labs drawn.

I have again developed tachycardia as I did during my last admission and my HCT has fallen to 26.
I am transfused with one unit of packed cells and placed on a Holter monitor.
My heart rate returns to normal.

My ekg and cardiac enzymes are checked and found to be normal.
The ng tube is really beginning to irritate me.
I note that it is periodically attached to a vacuum where the dark green bile substance is removed.
I need to blow my nose and frankly, it is in my way.

Later that same day I walk with assist and even alone to the bathroom where I void . I quickly become quite adept at draping my various tubes, wires and drain as I move about without tripping or becoming ensnared.
When Dave comes in we walk around the unit and I make a note of where things are located (linen, kitchen) so I can help myself.
I practice the incentive spirometer when I think of it-the staff tell me my lungs are clear and I want them to stay that way.

Day two post-op.
Dr. S. removes the ng tube. My bowel has "awaken" and my bowel sounds have returned.
I will now advance to sips of water-she does not want to rush things.
I don't really have an appetite yet, but the water is soothing because my mouth is so dry. I continue on IV hydration.
She also removes my dressing and I see my incision for the 1st time.
I do not have staples- but rather dissolvable sutures and steri-strips-(I am happy about this.)
It extends from about 3 inches above my navel to just above my pubic bone. It is about 11 inches long!

Day three post op
I have advanced to clear liquids. I am already tired of it-beef broth yuck! Sickeningly sweet jello (((shudders))).
My bowel sounds are loud and clear and I have began to pass gas.
This may seem an odd thing to note, but it is vital information to getting my diet advanced and my progress moving to discharge status.

Day four post-op
I am pretty much independent.
I awake each morning and take a walk around the unit, as I do several times throughout the day.
I get my clean linen and ice chips.
I am careful to lift nothing heavy or over-extend my reach or bend.

I take care of my own hygiene and grooming, and my next goal is to have a bowel movement so I can finally go home.
I advance to full diet today. The food makes me nauseous.
Not because it is any worse than your typical institutional fare,
but I suspect the pain meds I take are the culprit. The PCA was discontinued yesterday and percocet nauseates me to the point where I only take it if I am miserable-it is constipating as well and I wish to avoid that. Dr. S. has offered to try me on another med, but I just want to avoid narcotics altogether. I'm finding that the more active I am, the better.

Later after eating I have strong abdominal cramping and loose, watery stool.
Not exactly what I was hoping for but the circle of peristalsis is complete.
Lab work has shown that my potassium is low and I attempt to take it via the oral elixir.
It is so disgusting that I immediately begin to heave.
I can't believe that as a nurse, I have given this to people and watched them drink it-gross!

They give it to me IV and it burns so bad that the rate must be slowed to a crawl,
and heat packs placed about my arm.
Finally that is done and I bring up a possible discharge date. It is Sunday and the on-call resident who visits me, says that Monday is a definite possibility.

Day five post-op
It is Monday, 6/4/12
Dr. S. comes in and removes the drain-my final tether! (well except for the hep-lok). My wound and labs look good.
I am tolerating a full diet and voiding well. I am ambulating and capable of self-care.
I am passing gas and have had the prerequisite bm. I have good pain control and am pretty much getting by with tylenol and heat packs.
She is ready to send me home, but not without caution.
I assure her that I will follow all post op instructions to the letter and will call her and /or return to the hospital with any
unusual symptoms.

My nurse comes in and takes out my IV.
Dave is here. We go over the discharge instructions to the letter.
I tell the staff goodbye and we are outta there!

And for the record, the procedure I had is called cytoreductive surgery which consisted of an Exploratory laparotomy, total abdominal hysterectomy, bilateral salpingo-oophorectomy and total omentectomy of the greater and lesser omentum.
Specimens taken for pathology were from the uterus, tubes, ovaries and omentum and fibrous tissue from the small bowel.
The total pathology report is estimated to be completed in two weeks, but my post-op diagnosis is primary peritoneal cancer stage 3c.
Primary peritoneal cancer is felt to begin from ovarian cells and looks identical under the microscope, and is treated the same.
Dr. S. feels that my surgery went very well and that the neoadjuvant chemotherapy was successful in greatly reducing the number of nodules and lesions that showed on the original CT.

And that is all as I can recall it.
I feel stronger each day and will be seeing Dr. S. for my follow-up visit next Friday.
I'll have another update then.


Sometimes I go about in pity for myself, and all the while a great wind is bearing me across the sky-Ojibwa Saying

No comments:

Post a Comment