If you’re having surgery, read this

If you’re having surgery, read this

having-surgeryIf you or someone you love is having surgery, you really should read this, because it could save you time, trouble and complications.

I know people don’t like to read. But this could help you a lot. So I’ll break it down into a couple posts.  Each nugget of advice can be found in red type.

The Background

We live in the San Francisco Bay area, with access to some of the finest medical care in the world. Excellent insurance. A PCP extremely well-connected to the finest surgeons, oncologists and others. In fact, we engaged her after I watched her quarterback horrifically serious illnesses for three friends. It has paid off in the specialists she’s gotten us in to see for various issues. We’re lucky we can afford her.

The Symptoms

Post-menopausal bleeding. Which I tried to ignore. But I knew that any post-menopausal bleeding was a sign that something was wrong. After a couple weeks, I couldn’t hide my head in the sand any longer.

Ultrasounds showed abnormal thickening of the uterine lining. I needed a biopsy.

having-surgeryMy GYN

She’s very good. She’d done an in-office biopsy before, but this time, she couldn’t get a grip. Literally. My choices were to go under anesthesia for an outpatient biopsy and deal with what to do later. Or…

….just have a complete hysterectomy and a biopsy in the OR.  Far too many I know have dealt with GYN cancers and some have died.  Even if I was in the clear, I didn’t want cancer to brew later. So I wanted it all gone. Done.

My Surgeon

Because my cancer status was unknown, my GYN would assist at surgery but a well-regarded GYN oncology-surgeon would actually do the procedure ,ust in case, with high-tech robotic assists. I liked him. I knew he had a good reputation. Neither doctor really thought it was cancer but, as a surgeon told me 30 years ago when he removed a breast lump: “I’ve been wrong.” Better safe than sorry. My breast lump was benign. I thought my uterus would be, too, but who knew? Had to find out.

The Surgery

Most hysterectomies today are done laparascopically. Four little holes. And my surgeons was expert at robotic assistance. I tried not to think about the article I’d read years ago about complications from robotic assists.

Some 30 years ago, I’d had uterine surgery to remove a boatload of fibroids. At the time, I hoped to bear children. That didn’t happen, though.

“This isn’t going to be one of those easy hysterectomies,” my surgeon told me. “Your prior surgery means that you have scar tissue, which tends to adhere to all sorts of stuff, like the intestinal wall. You will probably require an abdominal incision, too.”

I knew that meant recovery time would be longer, since I’d had that incision 30 years ago.  I knew what to expect.

KNOW WHAT TO EXPECT If you’re having surgery, make sure you know what to expect, too. No surprises. In advance of your appointment, list all the questions that might come up if you are having surgery, no matter how stupid you think they are. Ask about the preparation, the surgery and the recovery. Ask your surgeon all of them.

having-surgeryPre-Surgery Tests

My surgeon wanted three things to clear me for surgery: an EKG, a chest Xray and a blood test. I’ll just say straight out: do not delay: do those as soon as you doctor wants them done. In case there are further tests. I got pretty squeezed because I put those tests off.

My EKG required further testing: an ultrasound. And what a scare it was to have to go through this because of an abnormality.  My internist got me into an excellent cardio and she reassured me all was well, then gave me a new blood pressure med to stabilize me before surgery. Another reason to get those tests done as soon as your surgeon wants them.

My chest Xray. Mention that to any former smoker and you can see the naked fear in their eyes.  When I had surgery 30 years ago, they “found something alarming” on my chest Xray. It turned out to be nothing: something I’d inhaled years ago that had calcified. Until the CT clarified it back then, I was terrified. I figured this would happen again so I explained to the nurse. She told me how to find the old Xrays. But the hospital didn’t keep 30 year old xrays –no way to compare. So I waited for the call.

Just when I thought it wouldn’t come, it did. I needed a CT. And while there was no lung cancer, my surgeons’ nurse ran me through some alarming questions about my lung health. She was puzzled that I didn’t have lung symptoms, a history of pneumonia, been hospitalized for it, etc. This really was alarming.

However, I got cleared for surgery at almost the last minute. So get those tests in the appropriate time period.

The Hospital

having-surgeryMy late BFF spent time at Stanford Medical Center and complained about the constant doctor exams. Teaching hospital stuff. So I was thrilled to know that I would be at  an excellent (different) hospital where I’d had my 3 surgeries 30 years ago. (Yes, three: breast lumpectomy, myomectomy (fibroid removal), gall bladder. I figured it would be as good as it was 30 years ago. I figured they’d have a hospitalist (a dedicated in-house doctor) and I’d avoid having a dozen student docs constantly barging in.

Hold that thought.

The hospital began emailing me with a link to maybe 20 short videos about my surgery and then, when I scanned and decided not to watch them–so many! Then they began calling me with recorded messages admonishing me that I hadn’t watched them and needed to.

No I didn’t. I did not. And I did not like this harassment.Very high tech and very low touch.

Medications List

Nurses and admins went over my current medications list at least a half dozen times, either in phone calls or at the doctor’s offices. The high tech medical info system spit out a list of every single thing I’d taken over the past 10 years–including meds my doc prescribed before travel “just in case” and mega doses of prednisone I took when I lost my hearing –and assumed I was still taking them.

“No,” I told them. “I take two regular meds and now I take the additional BP med.” I corrected them each time. Including the night before surgery.

Make sure they know exactly what meds you actually are taking–and correct them as many times as needed. Make a big deal about this because it may affect what else they prescribe after surgery.

having-surgeryDoctor contact

At my presurgical briefing, the surgeon’s nurse told me “You won’t see him, and if you do, you won’t remember it.”

Ok, that seemed right for day of surgery. I knew I’d be out of it. She gave me a folder full of information.

The afternoon before surgery, the hospital called to go over when to stop eating and drinking. I had a handout from my surgeon so I knew already, but they did a final review. “They typically assign anesthesiologists at 5:30pm so. you should get a call from yours before 9:30pm.” That’s what I was told.

I waited. My super early surgery time meant I had to get up at 3am but I left my phone on. No call.

In the pre-surgery prep room nurses efficiently got me ready. The anesthesiologist popped her head in to say hi. That was it.  They rolled me in and within 2 minutes I was on the table and the anesthesiologist was saying “I’m giving you medication to put you ….” Lights out.

Make sure all of your questions about anesthesia are answered in advance. Do not wait for the doctor to call you because she may not.

having-surgeryRecovery Room & Hospital Room

I have no memory of it. I have no memory of getting to my room. None of it. Eventually some of my wits returned. In my room I had some discomfort and they gave me a dose of ibuprofen.  I noticed I had a roommate and wondered why.

Make sure you know if you are in a private room. Or not.

Seeing a doctor

I never saw a single doctor in the 30 hours I was in hospital. My surgeon didn’t drop in. My GYN didn’t drop in. A resident poked her head in to say hi but didn’t examine me nor did she ask me a single question about how I was feeling. I never saw a doctor on the floor. Not one.

Does it matter? Yes. It matters to me.

Make sure you ask who will check you in hospital. Do not assume any doctor will.

Pain Meds

I was given the usual week’s prescription for oxy. I didn’t need it. I used hypnotherapy and didn’t take any pain meds at all. I didn’t need them. Nor did I want them. As a hypnotherapist, myself, I know hypno works. I have clients for whom it has been effective and it worked for me, too.

Consider alternatives to pain meds. You don’t have to ingest anything to manage pain.

having-surgeryAfterwards

A few days past surgery I had a nagging sore throat. I called the surgeon’s office. The triage nurse kept telling me it was from the ventilator. That made no sense because ventilator-induced sore throats happen right away and this was days later. After my second call, I saw my internist.

“You have viral laryngitis,” she said. “You have a rash indicating virus.” So much for the surgeon’s triage nurse.

I had a whopping incision because it was not a straightforward surgery. I followed written incision care instructions to the letter. They warned I was not to mess with the surgical glue, so I was extremely careful in the shower.

After about a week I knew I had a bacterial infection on the wound’s skin. I could smell it. After several calls to the surgeon the nurse wanted me to send a picture of the red incision and when the nurse-practitioner there saw it I was finally invited in for an office visit. Yes, I had a skin infection and was given a cleansing wash and an antibiotic.

Do not trust that your doctor’s office is correct. Use your own judgment and yes, that means you may have to keep calling as I did.

Final surgeon visit

At the two week mark I saw my surgeon. He did not examine me. When I explained my distress with my care he was quite taken aback. Because I was quite direct. At the visit end, which did not include an exam,  he cleared me for all activity, including aerobic exercise.

Did I hear that right? I had major abdominal surgery with a huge incision and I could go dancing around? He hadn’t even examined me and I was still spotting!

Fortunately, I used my own judgment. When I was still spotting at 6 weeks I saw my GYN. “You’re not healed,” she told me. “It’s because you’re older and healing is slower.”

“But I was cleared for aerobics a month ago,” I told her.

She paused. “I’m a little more conservative than that,” she responded.

Being in an area known for great medical care does not guarantee you’ll get it. You have to push for it. And even then you may not get it.

I’m a knowledgeable consumer. A doctor’s daughter. And I still got substandard care.

So there you have it. Lessons learned for me, and now I’m sharing with you so you don’t have to go through what I did.
{ {  If you’d like to use some of the tools I found effective for my own recovery, see them all right here.   } }