The most amazing surgery story ever – part 3

(January 20, 2016 “The play-by-play”)

WARNING: This is slightly graphic, so if you aren’t comfortable reading medical details, please skip.

During the night, it occurred to me that I should go ahead and document what I remember (or was told) about the details of my hysterectomy yesterday while they are still fresh in my mind, so here goes.

Like much of medicine, it seems that hysterectomy has evolved a LOT in the past 30 or 40 years. Back in the day, it meant a major abdominal incision, all one’s parts lifted out and strewn across one’s abdomen for sorting and removal, the remaining items re-inserted into slot B, and all the layers of cut muscles and tissue (I was told it was six when I had my first C-section) meticulously sewn (in later years, the outer layer was stapled) back together. It also meant a several-day hospital stay and a six-week recovery.

Then somebody figured out how to do these surgeries vaginally, which meant somewhat less pain in a different place, and a somewhat shorter recovery.

I don’t know who came up with the idea of doing hysterectomies laparoscopically, but my understanding is that they make several very small incisions across the abdomen, and a camera goes into one and tools and such into the others, and the deed is done robotically.

Dr. Shibley used to do them that way, but in the past several years, he has come up with and refined what seems to be an even better technique that has a recovery time of only two weeks. In fact, he told us he did this procedure on one patient who is herself a surgeon, and FOUR DAYS LATER she was back doing surgery! I don’t know exactly how he does it—and I missed my big opportunity to observe it by being unconscious for ninety minutes yesterday—but he does it all (camera, instruments, etc.) through ONE one-inch incision in the navel. Here’s how he explained it to us the day before the surgery and again a few minutes before he operated.

Oh, but first, and not to insult anyone’s intelligence, I should explain a bit of female anatomy, as well as my particular situation. Center stage in the lower female abdominal cavity is the uterus with two Fallopian tubes attached to it on either side, and attached to the far end of each tube is an ovary. The bottom of the uterus is connected to the cervix, which is connected to the vagina. Think the “Dry Bones” spiritual. = )

I have no cancer or pre-cancer concerns. My problem was my eternally bleeding uterus, which needed to be removed. Current protocol is to remove the Fallopian tubes along with the uterus, because (A) if you’re not going to have a uterus, you have no need of any Fallopian tubes, and (B) cancer could potentially develop in them in the future. We wanted the uterus and Fallopian tubes OUT. However, my ovaries (which are still wheezing along after 44 years and producing some amount of estrogen—a very good hormone to have floating around in a woman’s body) and cervix are all in good shape, and we wanted to keep them.

So, for my “hysterectomy and bilateral salpingectomy” (removal of my uterus and both Fallopian tubes), the procedure was as follows:

~ Arrive at the surgery center, don fashionable surgical attire in my little out-patient surgical “room” (like a curtained E.R. cubicle), fill out forms, take vitals, start IV, ask and answer questions with nurse

~ Wait a while

~ Play gin rummy on tray table with husband

~ Learn that things are running about 30 minutes late, so wait a little more

~ Lose gin rummy miserably to husband

~ Meet with Dr. Shibley, who reviewed the entire procedure with us, explained exactly what would happen, including what he would do, how I’d feel, and what to expect. He also told me that he had a new “tool” he’d be using on me, a liquid pain-relieving drug that he would inject (during the surgery) into my cervix and navel area. It’s called Exparel, and it’s an anesthetic med encapsulated in microscopically small “beads” that gradually dissolve over three days, making it a “timed-release” novacaine-like pain med. He said it would leave my belly button rather numb for three days (totally fine with me!) and make my recovery even easier. He then used something akin to a purple Sharpie to draw arrows on my abdomen to remind all parties to take out both Fallopian tubes, and he added a smiley face.

~ Meet with Dr. Kallitz, anesthesiologist. He was superb; took lots of time to ask questions and hear my concerns about past difficulties coming out of anesthesia. He told me that through my IV (all meds but one would be administered through IV), I’d be given a mild sedative as we rolled toward the operating room. Once we were in there, I would be helped onto the operating table, and then I’d be given major “knock-out” drug(s) mixed with an antibiotic and two anti-nausea meds. Once I was asleep, they would put a mask on me and I would breath whatever inhaled med would keep me unconscious as long as Dr. Shibley needed. I would be intubated (breathing tube down my throat), and a urinary catheter would be inserted into my bladder. My abdomen would be “painted” with some antiseptic liquid in an interesting shade of seafoam green.

~ Dr. Shibley would make his belly button incision and somehow do all the following through it.

– inflate my abdominal cavity with a large quantity of CO2 gas

I am not sure, but I suspect the purpose of this is to inflate my belly so that the organs to be dealt with are closer to the surface and more accessible?

– disconnect my uterus from my cervix

– disconnect each Fallopian tube end from its corresponding ovary

There are ligaments that hold all that stuff together, and all those supporting ligaments had to be cut. I asked him how the bleeding from those internal cuts would be controlled. It’s done with a specially designed device that utilizes a combination of ultrasound and heat to cauterize the blood vessels. This is more effective (gives a better and stronger seal to those vessels) than conventional, heat-only cauterization.

– do the zip-loc routine

This is a procedure that Dr. Shibley developed to solve a specific problem. Evidently this is his own technique so he is the best in the world at it, and it’s gradually becoming the standard where other surgeons have been able to be trained to do it. I will try to explain. It is suspected that some female cancers may actually originate in the Fallopian tubes. Doing a laparascopic hysterectomy (making only several tiny holes in the abdomen) means that the entire uterus needs to be pulled out through one of those holes. Think ship in a bottle. To do this, the uterus has to be “ground up.” I think the word he used for that was maybe “maceration?” So they generally “grind up” the uterus (and the Fallopian tubes, which are usually all removed as a set) with some certain instrument and then pull it all out the tiny hole. BUT there has been concern that in so doing a few cells may be left behind in the abdomen, and if any of those cells should HAPPEN to be cancer cells that were developing in the Fallopian tube(s), then they could set up a cancerous growth somewhere sometime in the future.

So. . . to alleviate that problem, Dr. Shibley has developed a technique (and I don’t know any more than what I am saying here) of somehow using an instrument he designed for this purpose to put the disconnected uterus/tubes in a “bag” and grind it up in the bag so that no cells are lost, and then pull the bag out through the navel incision. Isn’t that totally amazing?!? I don’t know the real name for it, but I refer to this as his zip-loc procedure, because it sounded a lot to me like when I attack a bunch of graham crackers with a rolling pin in a zip-loc to make crumbs.

– examine everything else (ovaries, cervix) to see if there are problems that would necessitate their removal

– inject the special numbing juice into my cervix and navel

– suck as much of the CO2 gas as possible out of my abdominal cavity; if bubbles of it are left inside, I could have cramping and pain

– removal all tools, and sew up the navel incision with one or two stitches

I am told that once my belly button was sewn shut, a number of other things were done. My urinary catheter was removed. (I hate that and was so glad I was unconscious to have it taken out!) My breathing tube was removed. My mask was removed. My IV meds were altered to bring me gradually back awake, and yet another anti-nausea med was added to the mix.

I was wheeled to recovery and Scott joined me there.

I was actually totally unaware of nearly ALL the above. The last thing I remember was my gurney being wheeled from my cubicle toward the operating room, but I never even saw the doors of that room. The next thing I knew was that I was dreaming, and someone in my dream was using medical terms, and I wanted to open my eyes but could not, and I wished they would all be quiet and let me sleep, but they would not, and I finally figured out that I wasn’t dreaming and that they really were talking to or about me. And I managed to get my eyes open, and I recognized my new good friend, Nurse Theresa, next to me. It was nearly 3:00 PM.

From that point on, they kept asking me about pain (I had almost none) and if I wanted pain med (I did not). My belly button gradually began to ache, and I took a Percocet at about 3:30, but by then, I was awake enough to talk relatively intelligently. Within an hour, and leaning very hard on Theresa, I walked three laps around the unit. They wanted me to pee before I was discharged (the bladder gets kind of numb and sluggish with both the anesthesia and the surgery itself), and Theresa did an ultrasound of my bladder to measure how much urine was in it, because that would supposedly indicate whether or not it would be possible for me to urinate. There’s no point going through all the motions of getting onto a throne if nothing can possibly happen. 30 ml. That’s two tablespoons. Definitely NOT enough to go; that despite having received 2000 ml through my IV! So we thought I was going to have to drink a whole lot of water to get things going, but I got into the bathroom with much assistance and did, yea and verily, pee. Hallelujah. Sometimes it’s the little things that matter. = )

Scott had already been given my discharge instructions. He then helped me dress, we collected all our toys, Theresa wheeled me out, and we drove away, stopping at Chik-Fil-A on the way “home” to pick up Cobb salads for supper. Amazing. Totally amazing.

Back in our room, I spent a couple hours just sitting around, typing up an update, and eating part of my salad. We were on the phone quite a bit that evening about stuff at home—a major ice event resulting in four other friends being stranded at our house with Josiah, and Andrew unable to get home from school and overnighting with another family in Reeds Spring. Scott and I played another game of gin rummy, which I won decisively, I took three ibuprofen, and we went to bed.

Sitting down, my pain is zero.

Getting up and down is somewhat uncomfortable, and getting in and out of bed (lying-to-sitting and vice versa) is actually painful (I yelp a bit), but Scott has been doing most of that lifting and lowering, which is wonderful. I can walk slowly and without much pain, but it’s nice to have a supporting, husbandly arm, and I am now firmly convinced that nearby walls are a simply brilliant idea. And did you realize that they are almost everywhere?!? Never noticed ‘em so much before. . .

My steri-stripped belly button is hanging out for all (well, really only Scott and me) to see. As long as my clothing is rolled below that point and nothing is touching it, all is well, but if someone were to bump into me from the front, I am sure I would scream, and I definitely could not be held responsible for any subsequent retaliation.

I took a shower this morning and managed to dress myself, but I think I will let Scott deal with my socks and shoes next time. The issue is just that they are so darn far down there! A bit of bending is required to access them, and bending is emphatically NOT good. Neither is coughing (which I must do, because my throat is—expectedly—somewhat raw from having the breathing tube down it) or laughing (which I like to do, but am endeavoring to avoid).

I know that the Percocet can be constipating, so I am trying to avoid it. So far, ibuprofen has been sufficient, but I may do the Percocet tonight, or take Ambien, so I can sleep. Last night I lay there wide awake for several hours. No pain once lying flat, but also no sleep.

It snowed about an inch here last night J, and the temp was up to 14 this morning.

There is evidently some concern about blood clots, so I need to walk a little every hour or so. It’s now time for that and for me to drink more water. Then I think I will take a nap. = )

God is great, and this experience has been wonderful!

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