Monday, January 4, 2016

The Real Story: Hysterectomy

Photo Credit: Matthew Wiebe

I woke up writing this post in my head which is a pretty good indication that I am officially on the mend. I am starting this post 1-week post surgery but finishing it over the course of the whole month. In some ways the recovery has been textbook, but in other ways it rocked me. There are a few different ways to have a hysterectomy, and different things to take out (depending on the reason for the hysterectomy), so I can only speak to mine. Given the fact that there are about 600,000 hysterectomies performed each year and it is the second most common surgery for reproductive aged women, I figured it would be good for me to share a bit of my experience.  Besides, I am a blogger and that is just what we do!   Warning though - there may be parts of this post that would qualify as TMI.

Well, let's get on with it then...

If you have a vaginal hysterectomy, you it is generally an outpatient procedure and you are home that same day.  No such luck for me. I had my procedure done abdominally - they went in through my c-section scar thus cutting abdominal wall - and they took the uterus & cervix & fallopian tubes, leaving the ovaries intact. I also had a mass removed from the abdominal wall between my muscles and the skin.  It was expected to be endometriosis, but as it turns out it was a golf ball sized mass of nerve cells called a neuroma.  My uterus had adhered to my bladder and they had sort of grown around into another, so they took a few hours and gently separated that as well. That last part was unexpected and the whole surgery was 4-5 hours.  That is a little longer than most hysterectomies.  I was in recovery for a few hours too, so I have about 10 hours of 'mystery time' while I was out or incoherent.  I was in the hospital 2 nights and 3 days, and it has taken about 5 weeks to fully recover.

Prepping for Surgery

The hysterectomy really starts the day before with your bowel prep. Yuck. It's really not that bad if you can get past the taste of the medicine. Actually taste isn't really the issue since it is supposedly tasteless and odorless and you can mix it in your choice of drinks.  It is just a little slimy.  I mixed mine wrong so I had a super concentrated drink but it was faster to get down which is a good thing I guess - then I followed with lots of clear liquids that I LIKE to drink.  I was super worried about being starving all day and into the next, but in reality my insides were so full with liquids it wasn't a big deal (until the next morning!). You just need to make sure you can be home all day (no carpool duties!) because you may have to make a run for the loo. It took about 3 hours for the medicine to kick in and again - not so bad. 

The morning of the procedure you are NPO- no water, no food, no nothing. My procedure didn't start until 1:00 (initially scheduled for 7:30, moved to 9:00 and then postponed till 1:00), so by the time they put the meds in my IV I was ready for a burger and milkshake. I just kept thinking how important it was to have an empty stomach, bladder, and intestines since the surgeon would be poking around in there with sharp objects and all. That kept me from complaining too much. I would just imagine one stray nick of the knife and my abdominal cavity becoming septic - gross!

Sidebar which may constitute TMI - let's talk about waxing.  Following my last (4th) c-section, I was left with a pretty funny looking haircut.  The prep team shaved me sideways and fairly completely across the top.  Grow back was itchy and weird and a little embarrassing.  So this time I decided to take a plunge and get waxed.  It was horribly painful. Don't let anyone tell you it isn't. BUT, when I showed up at the hospital cleaned up and ready for the surgery I was really really glad no one was going to be taking a razor to my nether-regions. So think about it.  Maybe waxing before your procedure would be a good thing? Now back to business...

Since I was at a teaching hospital I had a full crowd in my room.  I think we counted nine people who would be in the surgery.  Yes nine. Again, I was glad I had waxed.  Once they push the meds through the IV it is off to dreamland and you snooze while everyone else works (or watches) or waits.

The Aftermath
I 'came to' about 10 hours later in a dark hospital room. We had arranged for my mom to stay the night with me in the room. The girls were with my brother and SIL for a few days and the boys were at home with my hubs. I spent the next two nights and two days in the hospital in varying degrees of pain and discomfort.  They started me off with a morphine pump which I guess worked except itching is a side effect of morphine and that was almost as bad as the pain. I say that will full knowledge that the pain would have been worse. My husband says I was miserable in recovery, but I have no memory of that thankfully!

The nursing staff knows what to do generally.  I got a wonderful abdominal wrap. It has been seriously the best thing ever. I will be able to wear it when I start exercising again and it will help as I rebuild my abdominal muscles.  It is like a giant ace bandage/girdle and it helps stabilize the area and probably reduce swelling too. They give me pain medicine and that helps with the surgical pain. The ibuprofen helps with the inflammation and general soreness.

About 24 hours post surgery, I was feeling pretty well and walked around a bit. They started the Percocet and took away the Morphine pump which helped reduce some of the itching and thankfully meant I was disconnected from much of the monitoring.  The moved me to Percocet (which is oxy and acetaminophen) from the Morphine and again I itched, plus that can cause constipation and headaches. I was less concerned about the constipation (they give you stuff for that and after all you have a totally empty GI system) but the gas pains were horrible.

You have to realize they cut you open, expose your abdominal cavity to air, pull out your parts and then put them back in as they see fit. It isn't exactly like a jigsaw puzzle either. You are missing an organ and the intestines are not going to be wrapped up like they were before the surgery. They are flexing and stretching differently now too. After the c-sections I had cramping etc, but I really thought I would have less of that this time, because there was no uterus trying to cramp back into shape. I didn't realize that a lot of the cramping is the rest of the abdominal cavity, muscles and organs, shifting and adjusting too to the trauma it has been through.

And then the migraine started. By Friday morning I was begging for migraine meds. The doctor had ordered them before the procedure, but my night nurse didn't seem to realize the difference between a migraine and a headache. Most of my nursing staff was awesome and amazing - this one was not. When I asked for the bedpan she realized I was serious. Around shift change Friday morning they swung into action and began to get my head under control. I didn't even notice any abdominal pain. The migraine subsided by the afternoon, they took out my catheter, and once I was peeing I got to go home.

Going Home

By that afternoon the head was throbbing again. This headache was like a migraine in intensity, but as I lay in bed with my head packed in ice I began to realize that the Percocet headaches are different. Migraines get worse with movement, sound & light and are often on one side of you head. Mine are alway on my left temple and it feels like someone is sticking in icepick through the side of my head. The Percocet headache, while intense, was across the forehead and behind the eyes on both sides. It also got worse with laying down, and better when I would walk around. That meant it was worse at night and sleeping was impossible.

You need to weigh the +/- of the medications and their side effects.  The last few times I have had a general (for my ankle and then exploratory laporoscopy done before this) I have ended up with a migraine recovering at home hours after the procedure. We assumed with was a detox from everything they gave me in surgery. This time my head didn't start exploding until I started the Percocet, and it didn't stop until about 24 hours after I stopped the pain medicine. Given that a migraine is way worse than surgical pain, I stopped the pain meds about 24 hours after I left the hospital, as soon as I figured out what was going on.

Saturday I stopped the Percocet and the headache started to fade. At this point I was 3 days post-surgery and the abdominal pain was tolerable. I switched to Allieve which is always better for my head and is a 12 hour dose not a 6 hour dose (who wants to get up in the middle of the night to take medicine?) and things started to improve. Once the head was fixed I found the biggest issues were coughing and swelling of the vaginal area. With the wrap on my abdomen that swelling was under control but swelling is worse in the lowest part right? What is right below the abdomen? And how do you help that? You can't wrap or compress it and you can't really elevate that part of your body.  So ice packs was the answer.  Ice your parts. The nerves on the skin surface didn't really care about the ice so it was really helpful without being painful at all.

Sunday (Day 4) was the first day where I felt like I could hold a conversation. A lovely Eucharistic Minister brought me the Blessed Sacrament and some healing water from Lourdes (jackpot right?).  Monday (Day 5) was my first decent day. I got In & Out for lunch and it tasted amazing. It was my first real meal.

Recovery Timing
Each day has been a little better than before.  I have been wearing my fit bit and keeping track of my activity and being purposeful about doing a little more than the day before. The next few weeks will be a balance and I try to do more and my body tells me yay or nay. The worst two things are over and under-doing it.  Do too little and you don't regain your energy, do too much and you are in pain.

Keeping in mind that this was a more complicated (and thus longer) surgery, my recovery has been really easy.  I started writing this at the one week mark and I was off of all prescription pain meds, at the two week mark I was mostly off Ibuprofen too.  I started really getting up and getting dressed each day and at the three week mark I was driving and picking up some of the household duties again operating at about 75%.  By the middle of week 4, I was pretty close to 100%. I had a little residual pain where my neuroma was but that is not Hysterectomy related.  I am sort of going a "one step forward 2 steps back" as I try to do everything, then over do it, then find myself hurting again. That is frustrating.

Noteworthy Things to Pass Along
Hospital stay:  First, I loved having my own nightgown. It is a short one. Unlike after babies there is very little post surgical 'mess'. You have a catheter so you can't wear pajama bottoms and the hospital gown was HUGE and itchy and kept slipping down off my shoulders. I wish I had brought my own robe. I had a brought a comfy sweatshirt and I wore that over my nightgown when I went for my walks around the pod.

I also wish I had brought my own slippers. They gave me a pair of no-slip socks, but you wear those walking around and then have to take them off or wear them to bed. Too complicated.  A friend gave me fuzzy socks - those were awesome. Slippers would have been nice. And baby wipes. Those are always nice. And my own pillow with flannel case - I did bring that and it was a huge bonus.

I am such a nerd I always bring reading material. That was dumb. Who really reads while they are hopped up on pain killers? I had my latest novel and a few other religious books. They just loaded down the bag.

The hospital brought me food and gave me some choices but it was seriously disgusting. I ordered everything but ate almost nothing. I wasn't feeling hungry but my last meal had been Monday night. By Thursday and Friday my body was needing food. I had my husband bring me smoothies and that was a good option.

You will weight more when you get home. Just realize that yes, they took an organ, and yes you haven't eaten in days, but they also hooked you up to an IV and pumped you full of fluids.  It will take some time for your whole body to adjust. Don't worry. You need good, solid, non-gassy, comfort food to help you heal so put your vanity aside and eat that hamburger when you finally want it.

One week post-surgery and I can say that the surgery was a really good "choice" for me. The biggest pain was the headache stuff which isn't universal. Without that the recovery would have been better than the pain prior to surgery. Having the surgeon open me up that he was able to take an good look at everything inside too. What they thought was endometriosis was a big neuroma and they found endometirosis in unexpected places.  My bladder and uterus had grown into one another after the last c-section (very rare) and any subsequent pregnancies would not have been viable and left me at serious risk. We didn't have much of a choice, because I had multiple issues, but I am really glad we went with the surgery. That said no surgery should be entered into lightly. Having a procedure that will sterilize you and potentially put you into early menopause (if you take the ovaries too) is a big deal.  If you are considering this surgery be sure to look at all your options and above all remember to pray for peace and direction.  I will be praying for you!

Feel free to comment below or message me with any questions and thanks for stopping by!

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