My web site is devoted to medical and treatment information about this rare cancer. My blog is devoted to sharing what has been the more difficult part of the journey for me, the emotional and spiritual road I've traveled as a rare cancer survivor.

Tuesday, November 30, 2010

Getting Ready For Surgery

I've gotten several emails in which patients awaiting cytoreduction surgery and HIPEC have asked me how to best prepare.  We are often told, as I was, to expect a 12 hours surgery, to be in ICU for a few days post-op and to be in the hospital for about 2 weeks.  We've all heard horror stories of those who have had many complications and who have been hospitalized for up to a month, and who have had very long recovery periods.  Much of the length of hospital stay and probability of complications is related to the extent of surgery needed, general health before surgery etc.  I had few abdominal tumors, so probably required less surgery than many others.  My surgery, expected to be 12 hours, but was instead 5-6.  I did not need to go to ICU post-op, and was discharged in 6 days, not two weeks.  My recovery was not extended, I was back to doing what I normally did (albeit with some pain) in 2-3 weeks.  I also have a very high pain threshold, which also served me well.

There are things we can do though, to speed our recovery and prevent complications.  As a nurse, I know that those who don't move post-op have more complications.  So I was insistent on getting out of the bed as soon as possible.  Within 36 hours of my surgery, I was walking the hospital halls almost all day, every day.  Walking helps bowel recover normal function, prevents blood clots, promotes wound healing and prevents pneumonia.  When I wasn't walking, I was sitting in a chair in my room, I only went to bed to sleep.  I had to walk bent over for awhile at first as standing up straight made my abdominal incision more painful.

I personally didn't like the morphine PCA they gave me at first...one of those things where you press a button to deliver morphine when you are in pain. Morphine made me feel drugged....and nauseated.  And nausea and vomiting is a painful thing to do when your abdomen has been cut open.  As I was a nurse, I knew of a drug that was not narcotic, Toradol.  It is, in essense, a powerful form of IV medication for pain.  I asked my morphine be stopped and replaced by periodic Toradol injections  Toradol was so much more effective for my pain, and I didn't feel "drugged" or nauseated.   I was very lucky I had a physician who catered to my needs and suggestions.  Toradol can only be used for a few days, so after Toradol, I took ibuprofen for pain.Narcotics can depress breathing and slow bowel function also,so I felt I was better off without them.

I also brought books and a CD player to the hospital.  I needed things to distract me from my status as a patient, to distract me from pain.  Some hospitals now have internet access....you can bring your laptop and keep in touch with people if cell phones aren't allowed.   Many also use the Caring Bridge site and have a person designated to keep the site up dated, so family and friends can get updates and you or your loved ones aren't inundated with telephone calls while you are in surgery and recovery.

I also brought soft elastic-waisted pants and shirts as I didn't want to wear a hospital gown, so I was in street cloths most of the time.  I also bought something called an abdominal binder...it is like a very wide elastic belt you can wear to splint your abdominal incision that was very helpful to me after I was discharged (about $20 at Walgreens).  They used to be commonly used for patients with abdominal surgery, not sure why they aren't commonly used now.  It may have been sold at Walgreens as an elastic back brace, but it worked well as a binder.

It is also important to take several deep breaths and to cough every couple of hours; if coughing is painful, you can hold a pillow against your abdomen when you do it.  If you are in bed, you can do ankle exercises to help blood circulate in your legs to prevent clots from forming.

When I got home, I had no bowel or stomach issues, just didn't have much of an appetite for awhile, so I ate frequent small amounts of high calorie food (egg nog, milk shakes, ice cream sundaes).  My appetite did return and I gained back all of the weight I lost with my surgery (about 20 lbs.).

If anyone else has other suggestions as to what helped them through this surgery, feel free to post in the comments here!

3 comments:

Alice said...

Carolyn,

Binders are given routinely after abdominal incisional hernia repairs – I wore it for 6 weeks, and liked the support.

Other thoughts – I can’t tolerate the opioids either, and arranged with my dr to have a “walking” epidural placed before my surgeries for pain control after. I had bevicaine (?) through it for the first few days, on a patient pump through my epidural – no narcotic fuzz. The advantage was very good pain control, and I could still get up and walk around (yes, a must). The disadvantage (?) is that an epidural requires a foley catheter, which I didn’t mind, as I didn’t have to get out of bed to urinate. Much easier, although an extra route for infection. When the epidural was removed, I was given Toradal.

More hospitals are now advising Hibiclens showers before surgery – it cuts down on post-op infections. I know I took my 2 Hibiclens showers (night before and morning of) prior to my recent surgery, and had no complications. I had a major wound infection with my prior surgery, before those recommendations were in place. Anyone anticipating any surgery should ask about the Hibiclens shower protocols. It can’t hurt, and has been shown to be beneficial. If your surgeon doesn’t mention it, ASK!

Bring oversized slippers/crocs to the hospital. After my first surgery, my feet swelled up beyond belief. My brother brought me his daughter’s size 10 crocs, and I lived in them (and never returned them – they went with me for my surgery in June.)

Another reminder is to keep using the Incentive Spirometer (breathing thingy) that they will give you. That in conjunction with deep breaths and coughing will help to avoid pneumonia.

Also helpful to me this last time was noise-canceling headphones. My room had constant buzzes that the headphones helped me block out. As I’ve become hyper-sensitive to sound, this was very important to me.

Last, but not least, I brought my stuffed blue octopus with me. He traveled with me on my IV pole, and kept me company in bed. Others walking the floor enjoyed seeing “the lady with the octopus” and I liked having something silly, but important with me. (The octopus became my “totem” animal during my cancer treatment.)

Surgery is no fun, but somehow we get through. Consider all little tricks that others have used, and determine which ones may seem useful to you. Having had 3 abdominal surgeries now, I feel like I know the ropes all too well. Hopefully, there will be no more surgery – I told my surgeon that if he expected to ever go in again, he’d better put in a zipper. No zipper, therefore no more surgery.

Best wishes to all,
Alice

Carolyn Langlie-Lesnik RN BSN said...

Thanks so much Alice, great advice!

I meant to include the info on incentive spirometers, but forgot! I tried to use mine every 2 hours. I don't have any experience with the "walking epidurals", but they sound great!
There is a bit more infection risk and possibly a risk of urinary tract infections with the foley being left in, but if it helps with getting out of bed and walking, it may be a good trade-off.

I didn't do the Hibiclens and had no infections, but I think those are a good thing too...they can only help. I know of several who have had post-op wound infections.

In my early nursing days, abdominal binders were used routinely for all those who had abdominal surgery, I don't see that much anymore,I'm not sure why...but it really helped me! You don't realize how much you use your abdominal muscles until they have been cut and cause pain.

I never had the foot swelling, but the Crocs/oversize slippers is a good idea! I just used the hospital slippers.

Thanks again!
Carolyn

DENISE said...

Thank Carolyn & Alice

I will be having this surg soon................denise