Monday, April 20, 2015

How To Get Through Abdominal Surgery

A friend recently posted that she has to have laparoscopic abdominal surgery this summer and asked for advice.  I realized we've had some experience with this, from my c-section, to Mama's hysterectomy and complications, and then to my emergency small bowel obstruction and re-section.  Smaller than those procedures, we've also had a few D&Cs and two abdominal hernia repairs.  So, we've had some experience.  Which I thought I'd impart here.  But I will write that in no way does this post constitute medical advice.  You should listen to your doctor.

Beforehand (*if you know, of course!)
  • Sleeping Arrangements:  Figure out where you're going to sleep in the days after surgery.  Stairs can be a challenge; couches might not allow real rest.  I have found it easier and better, for me, to climb to my bed and stay on the second floor for a few days.
  • Ativan:  if you are at all prone to nerves, ask for a prescription for Ativan or the like for the night before and drive to the hospital.  It just dulls some of the often considerable anxiety.
  • Groceries:  Depending on doctor's orders, you might have a special diet.  We always have easy snacks on hand because sometimes your appetite is small and it's easier to eat lots of little things.  Crackers, granola, bananas, peanut butter, white bread for toast.  I also like to have my favorites on hand to tempt me--I like Cream of Wheat when I don't feel well.  And eggs over rice with soy sauce.  And marmalade on toast.  Also, drinks.  I like iced tea, homemade or other, also coconut water.  Kefir and yogurt are also good for the probiotics.  We keep some of these in the bedroom, especially the high-protein ones, to go with medication or late-night snack needs.  See Eileen Behan, Cooking Well for the Unwell, for recipes and ideas about nutrition--protein seems to be very important to healing.
  • Prescriptions:  Some doctors give you your pain meds Rx beforehand so no one has to rush out to fill it right after surgery.  Ours never did.  It would have been helpful, though.
  • Medical supplies:  
    • Because you'll do wound care at home, it's good to have supplies of gauze, paper tape, bandages, whatever, plus an antibiotic cream, if suggested.  Follow your doctor's orders for how to take are of it (mine wants me to use baby soap to shower!)  
    • If the surgery is gynecological in nature, you might need extra-absorbent pads.  The ones from the hospital are super bulky and don't stick well.  Have a supply of your favorite brand at the ready.
    • The hospital will give you a surgical binder; if not, Amazon sells them.  It helps to have two, for washing.  
    • You'll want pillows:  to hold onto when you sit or sleep, to give pressure, especially if you cough or sneeze (oh, awful.)  Also protects you from overly excited pets and little people.   A small stuffed animal would work as well--and be cuter!  (Like the lop-eared bunny ISMITE that my family brought.)
    • From my back injury, I love my little bed rail, which helps me turn over at night and get up in the morning.  Probably not necessary for a single surgery, depending.  But I LOVE mine.   
    • I also have a temporary suction handrail in the shower, which helps me stay balanced and get in and out.  You can get these at Bed, Bath & Beyond.  It's more for peace of mind.  And again, with my back injury, my healing was long and slow and these things were necessary.  Now that we have them in the house, I find they are doubly helpful post-surgery.  I'm not sure I would have bought them just for surgery.  Well, maybe the shower rail.  
  • Clothing:  Check your wardrobe for loose, baggy clothes that won't bind in the days and weeks afterwards.  I wear yoga pants and men's pajama bottoms with ties that can be tightened or loosened.  I also wear layers because my sense of temperature changes.  I also like having pockets.  Wear what is most comfortable to you.  
  • "Phone Tree":  Choose someone to be your point of contact to get the word out to loved ones when you're ok.  Cell phones and FB/email really speed this along.
  • Other helpful ideas:  
    • a tray table:  for eating on the couch or in bed; also very useful to protect your abdomen from pets while you're lying in bed.  The cats so love to sleep on Mama that she slept under the tray table for weeks to keep them from jumping on her tummy.  
    • a box or basket:  we both were always losing the telephone, cell phone, tv remotes, pens, etc in the bedcovers.  A little basket or box helped us keep track of things.
    • drinking cup with straw:  it helps to have a spill-proof cup with a straw, especially when you're still in bed.

What to Expect in the Hospital
Depending on the doctor and hospital procedures, your experience might be very different.  Of course, do what your doctor and hospital staff say.  In planned surgeries, there is usually a pre-admission appointment, with blood tests, maybe heart checks.  Often, you're assigned a day but not a time; you often get the time the day or two before . . . and even then there will almost always be delays.  You go, check in, and eventually they take you back.  Sometimes your partner can go with you; sometimes they have the partner wait until you are enrobed and on your gurney.  In the ER, Mama and I were only separated during my x-rays and my CT-scan.  There is always a lot of waiting and time moves so oddly in the hospital.  Eventually, they'll start an IV and then you're off.  For my recent surgery, I was unconscious before the gurney left my room to go down the hall (or at least that's how I remember it; Mama says I'm missing parts of my timeline.)  And then at some point, you'll wake up in recovery.  Often they don't have your partner with you until after you wake up.  I think I woke up and fell back asleep a few times in recovery--I don't even remember being transferred to my room.  But eventually you'll be transferred to your room.

Depending, you'll be on a catheter for a day or so, with an IV.  I wasn't allowed anything by mouth, but Mama was allowed liquids almost right away.  Liquids includes jello, broth, juice, etc.  You'll then progress to regular food.  Best. Meals. Ever.  Order whatever you like from the menu.  I always seem to crave the roast turkey with mashed potatoes and gravy, green beans or corn, and a roll, with chocolate pudding or rice or tapioca, and hot tea and gingerale.  That's two hospital stays now . . . but then, it's hard to mess that up.  Mama herself had a dozen or so meals of baked potatoes!!

They'll wake you up in the night to check blood pressure and temperature.  This is when people complain about not getting any rest at the hospital.  I didn't mind the visits, maybe because I always fell back asleep.

TV in the hospital is an odd thing.  I kept it on all the time, day and night, as did Mama (though, not when we had the babies.)  It is distracting background noise so you can't hear other people and all the beeping machines.  It's company when you're alone.  It keeps your mind off pain and worry.  I think it even helped me keep track of time--I could mark that an hour had gone by.  I always seem to watch the stupidest stuff that I'd never watch at home (and I definitely can't watch cooking shows in the hospital.)  Mama watched "Deadliest Catch," "World's Most Dangerous Roads," "Ice Road Truckers," something about Arctic gold, pawn shop stars, was there storage locker wars?  I watched "Ancient Aliens," "Swamp People," and others.  And there's always the Weather Channel!

I was shocked at how quickly they got Mama up and about after her robotic hysterectomy--that night, even (but only once the catheter is out.) Anyway, don't be surprised if they are constantly encouraging you to get up and walk, sit in the chair, even shower, pretty soon afterwards.  And the walking, while slow and painful at first, even with the binder, is so important, especially to getting your bowels working again and also to help break up gas pain, which can be very uncomfortable.  You'll need to either pass gas or have a bowel movement for them to discharge you--apparently, the colon is the last part of the body to wake up, so it's function proves that you are healing relatively normally.  No doubt they'll be giving you a stool softener and fiber in the hospital, with instructions for more at home.  Suffice it to say, the first few bowel movements are difficult, regardless.  But you'll get through them.

A note about nurses:  BE NICE.  I'm always confused about the hierarchy (tech, RN, APN, nurse manager, charge nurse, and others) of nursing staff in hospitals and the shift changes, even who is in charge of me; it's all made harder by narcotics!  Recently, our hospital has put up these great white boards where your tech and nurse sign in so you know their names.  Use their names.  They are people, taking care of you at one of your darker hours; they have to stick you and wake you up, even stick an NG tube down your throat, not because they want to but because you need it and it's their job to do it.  They have amazing resources--compassion and knowledge--that most will willingly demonstrate.  But if you are mean, rude, or even indifferent--trust me, because I see it weekly in nursing homes--your care will be less . . . careful.  I don't accuse nurses of hurting or punishing people who aren't nice--they're professionals after all--just that, well, trust me, you'll feel better if you're nice.

While they'll have so much of what you need at the hospital, including toothbrush and paste, soap, shampoo, and towels, you might be more comfortable with some of your own things.  When Mama was in surgery, I had her overnight bag in the car and I fetched it before I could go see her, after she was in recovery.  When I had surgery, she rushed home in the wee hours of the morning to throw some things in a bag, though I didn't need them until much later.  Some things we liked to have:
  • robe, for walking the corridors in comfort
  • slippers or shoes, also for walking the corridors.  Slip-on Merrills were great--supportive and non-slip, also easy to get on without bending over.
  • extra pillow (see above) for coughing and support, etc.  
  • cellphone and charger (longer cords that reach the bed are great, at hospital or at home!)
  • a set of clothes to wear home, plus extra underwear and socks
  • deodorant--there are always your own bodily smells in hospitals (earthy, sick, unfamiliar, distressing smells) and I like to lessen some of it
  • hand lotion and lip cream--it can get so dry in hospitals and I like the scents of my own products sometimes (funny, I didn't need my own soap and shampoo, though.)
  • if you have long hair, consider a scrunchy or hair band to hold it back.  

  • Mama was wonderful to bring me pens and notecards so that the kids had something to do while they visited.  Then we decorated my wall with them.  Goo also brought me a notebook to write in when I couldn't comfortable talk with the NG tube in.
  • I usually leave behind whatever flowers I receive with reception on my ward, a small thank you.  The kids also brought a big plate of Italian cookies as a thank you to the staff (I think I brought cookies to Mama's ward, too.)  And we had filled out numerous positive comment cards.  
  • There is just no predicting when doctors make rounds, though it can be really early.  I missed them on many of Mama's days and vice versa.  But they often answered our pages quickly, when we had questions.  It's amazing what the staff can do with email these days.  

Afterwards at Home
  • Discharge instructions:  Discharge always takes longer than you think it will, to get the doctor's sign off that you can leave and then have the right person come and give you instructions.  I was surprised that I could walk out of the hospital if I wanted to, but since it was a long walk, I opted for the wheelchair.  It reminded me of being wheeled out with the twins--I told them how two people handed me money for them ($20 and $50, I think it was) and wished us luck.  Mama took down my bag and fetched the car, while the kids walked beside me in the wheelchair (which they thought was odd.)
  • Walking (or that uncomfortable discussion of bowels!):  If you're home, your bowels have returned somewhat to normal.  But it doesn't really feel normal, especially after bowel surgery.  I'm sticking to a bland diet, no raw stuff (to avoid food poisoning and excess gas, which is awful), no gassy stuff even well cooked (cabbage, broccoli, beans), no oily or fried things which also cause gas, and food only from people or places I trust--I can't even bear the thought of food poisoning.   I have also found that several small meals are better than three regular ones, if only because a full stomach presses in odd places.  I also try to have yogurt or probiotics everyday, to repopulate my gut well.  But when I chose poorly or ate too much and didn't feel well, walking was my lifesaver.  Walk, walk, walk.  It moves things along, keeps me from being too sedentary, keeps a few muscles going, gets me outside in the sunshine, even helps me be social with neighbors.  Walking has been really really helpful.  Yes, I started slowly--just around my room, then once around the hall, until I could do 3-4 circuits of our ward.  Now I do 15-30 minutes up and down the driveway or sidewalk near the house (so I don't get too far from home) at least three to five times a day.  Not fast--I call it my "surgical shuffle"--just one foot in front of the other (I always carry my cellphone in my pocket, outside or even in the house, just in case . . . . )  I didn't do it enough after my c-section and Mama didn't do it enough after her surgery, but oh, it is such a help.   Both the nurses on my ward and even my surgeon commented how well I was doing with walking. Not just for bowels, but for everything.  I would say it's my number one recovery advice.  
  • Reflux:  speaking of food, it's good to have some kind of treatment for indigestion, especially in the beginning where I'd be napping or lying down after eating, which contributes to reflux.  Now I try to sit up for an hour or so after eating and not eat too close to my afternoon nap or bedtime.  
  • Pain meds:  I'm a firm believer in pain meds, in staying on top of the pain.  I don't worry about addiction, but then that's never been one of my challenges (my addictions are digital and edible, separately of course.)  I've been told that if you really need the pain meds, you can't become addicted, but I don't know.  I find it's best to keep a list of the times I take pills; otherwise, day in and day out, I forget when and what I took (I also sometimes just email Mama so that we're both keeping track.)  In the beginning, I took them as often as I could.  Then, I got the heavy dosage of Percocet down and switched to something less powerful, Vicodin (which I didn't know was less potent than Perc.)  Right now I'm on one a day, midday, when I'm tired and achy, to get me through the evening hours with the family so I don't hibernate upstairs in pain.  When the Vicodin is too much, I'll move to Tramodol or Tylenol with codeine.  Interestingly, I don't always recognize that I am hurting; I do notice that I get grumpy or snippy or sad or anxious, and THEN I notice that I've been hurting.  I try to take the minimal number of painkillers I need to stay comfortable, but sometimes I figure incorrectly (take too few) and hurt anyway.  It takes a lot of awareness.  I find I move more and do more when I'm properly medicated so it really is a major part of my recovery.  (When I was under-medicated for my back pain, I didn't/couldn't move much at all and that was a disaster.)
  • Meditative Tools:  To supplement painkillers, utilize your own familiar, personal technique for relaxing, being mindful, etc., be it a "happy place," meditation, or the like.  I found Toni Bernhard's How to Be Sick to be the most helpful thing I've ever read regarding pain management and mindfulness.  (See also here.)  Counting my breaths, acknowledging that all things change, focusing on the present and not worrying about the future, have gotten me through so much pain and, I truly believe, actually lessened my experience of the pain because I've minimized the suffering.  (Pain being the physical sensations, suffering being the mental thoughts about pain.  But others explain it better than I do.)  When I am not mindful, my mind goes to my deepest fears and anxieties about loss, illness, and death.  It is best to stay in the present.  But it takes practice and you will have days where it is hard to stay present (I'm having one of those days today, hence posting on my blog!)
  • Meals and errands:  Some people find it very hard to ask for help.  I've gotten better at it over the years and realize how much it really does make a difference.  I cannot begin to tell you how helpful it is to have people bring meals.  We have been on the receiving end of meals now maybe six times, beginning with the birth of the babies, and it is amazing.  Not only is it physically nurturing, it is emotionally uplifting to be embraced and enveloped by generous friends.  Even if you get a lot of pasta!  Besides, pasta is versatile, easy to reheat, and almost everyone eats it.  I've organized meals for others several dozen times, first using clumsy old email lists and now beautifully streamlined with my favorite site, Food Tidings.  There are other sites, some that even do errands and such, but I like this one, probably mostly because of my familiarity with it over dozens of uses.  But I have already written about organizing meals.  Being on the receiving end just helps immensely.   
  • Distractions:  Books might be too heavy or require too much concentration, though the heft  problem can be fixed with an e-reader or magazines.  I had fun going to the store to choose magazines for Mama before her surgery--lots of different titles she would otherwise never have read--civil war history, photography, cats, British travel, etc.   I also opt for constant internet contact--I can lose myself in Facebook and Pinterest for hours--as well as television.  Nothing like bingeing on Netflix.
  • Visitors:  Long recoveries reveal some uncomfortable truths:  some people just are not comfortable with illness or injury.  I won't say I've lost a friend over my back injuries or surgery; I've just noticed which ones aren't bothered by it and which ones are.  I like to have visitors and am thrilled that I can sit downstairs and receive friends.  It helps when I can be honest with them, if I need to keep it short or need to lie down in the middle or run to the restroom.  I'm usually tired afterwards, but with spirits lifted, it is worth it.  Friends make getting better so much easier.
That's all I can think of now, but I will add to it as more comes to me.  If you face similar circumstances, I wish you the best of luck, with quick and gentle healing.  Get well soon!

1 comment:

  1. What you have written needs some gentle editing then it could be used as a pamphlet or perhaps published in a weekly magazine. Might even make it to this side of the pond. Give it a thought