Thursday, December 03, 2009

"If the surgery doesn't go well, I have everything done so I don't have to worry about the holiday feast meals and stuff. If the surgery is uneventful it just means I am on vacation till January!"

That is a quote of what I said yesterday before my surgery.

Today I get to tell you : "I am on vacation till January!"

My surgery was uneventful for the most part. I had one complication that delayed me coming home- so I didn't arrive back home until after 8PM yesterday.

I arrived at the hospital at 11AM and my surgery was booked for 12:30PM. I was taken to the OR at 1PM. I was given a spinal (like an epidural) anesthetic so I was awake for the surgery. I was completely frozen from the diaphragm down. I could not sense hot or cold, motion, pain, touch....nothing.

I was not given any valium or a tranquilizer so I was alert for the whole procedure.

The anesthesiologist was a visiting anesthesiologist from Montreal. Apparently it is quite common for Dr.'s to use some of their vacation time to go try things out at other hospitals. They can use hospital fellowship to try out a new town to see if the hospital or town meshes with their lifestyle: for relocation, or they can go to a hospital that has rare equipment so they get to try it out, or he might want to work with a specific specialist who does some complicated surgeries so they do a vacation placement.

The surgeon and the two nurses and the anesthesiologist got along very well. Once they realized I was a cheery person they joked around a lot. They asked permission to tell some really raunchy gynecological jokes, and we were all just howling with laughter in the operating room. In the end it turned into a girls against the boys pissing match and the nurses think we (the girls) won!

We discussed our families and hobbies and our education and work pasts. One of the nurses was 38 yrs in OR and 32 at Southlake Hospital!

In the end the Dr. asked if I thought I could needle felt a Samoyed Husky for his wife....LOL
It is so typical for an Etsy seller to turn every conversation back to their love of Etsy and crafting........So look! I have a challenge for my vacation :)

The surgery was uncomplicated which surprised the Surgeon. Everyone was prepared for anything. I was referred to as: "The neurological disease patient", and apparently neuro patients are a challenge because absolutely anything can go wrong and will go... and they cannot even predict how it will go wrong. I ended up a miracle with really nothing happening.

I spent about an hour in the recovery room. I got to watch all sorts of folks wake up from their surgery. I really saw how difficult it is to be a recovery nurse. First of all I want to tell you that at Southlake Hospital in Newmarket, ON the recovery nurses are kind and cheery. They are instictual with their monitoring of the patients. There is usually one nurse for every patient and then once you begin to respond well they can add another patient so the nurse has no more- then two patients at a time. Children get two nurses per patient. Everyone who woke up from surgery except for the patients who had their noses operated on was combative and confused for a few minutes while they were waking up-after the tubes are removed from their throat. Everyone tried to move or touch their surgical area and had to be safely restrained by the nurses while they came around. This restraining is not with a tool but by having the nurses hold the patients wrists and keep them away from the body and then talk to them in a gentle manner so they begin to understand what has happened. They would try NOT to grab the patients' wrists hard yet still hold them, so it meant the nurse would become a rigid post so the patient was blocked from their own face or body. These women are all small. This has to be hard to do. I was absolutely amazed. They have to be so tough and speak so kindly and gently to the patient at the same time.

I could never do that. I would forget and say something snappy.

Once the patient comes around they finally listen to the nurse instead of panic and they stop trying to touch themselves and peace sets over the patient and they just relax and let their oxygen and meds kick in.

The nurse manager never sat down the whole time I was there. She had a walkie talkie and would get paged on it when the OR was ready to bring in another patient and she would tell them which bay was available for the bed.

I also noticed that there is a special relationship between the Dr's and the Recovery nurses. The Drs tell the recovery nurses everything. It is like they are their mothers. They tell the recovery nurses all their news and ask advice. It seems the Dr.'s hang out in recovery between OR times and write their reports cuz it is usually fairly quiet in there. There is time to talk when you are checking out stats and examining the patient when they are asleep. It is very obvious that the Surgeons would be lost without their OR and Recovery nurses. It is like they are all best buddies.

The step down unit has a different dynamic. It is busier. Everyone is awake there and basically two things happen there. The patient finishes their protocol in that room and is medicated, and then they are discharged/or admitted.

It seems there is one nurse for every 3 patients and when one is ready to discharge, and is waiting for the Dr. to sign them out they can take a 4th, and this is when there are no complications. Complications require one and one care. If complications arise and there are not enough nurses for the protocol- the nurses from OR recovery will float in as their patient numbers lessen.

Step down has rules for patients that cannot be broken. Most of the patients have a time rule. The surgeon sets the number of hours the patient must be in recovery and step down and there are no exceptions on the minimum amount of time the patient must stay.

I had a different rule. I was told that spinal patients cannot be timed as there is no way to know how long it will take before the patient can walk, and the patient must be able to stand and walk with aid. The big rule for me was I could not leave unless I pee'd.

All day that is what I was told. I waited to thaw out and the nurses reminded me constantly that I had to pee. They gave me tons of IV fluids and had me drinking ginger ale, water, and tea over and over again. Finally I began to feel hot and cold. I could move my hips but I could not bend my knees or flex my feet yet, but I could wiggle. I also felt like my bladder was full but it didn't feel urgent. So I was feeling pretty confident I would be able to pee.

It seems that often the bladder and urethra forget how to work after the spinal and they have to be woke up. Some folks get a full bladder and cannot pee. Then they end up having to be catheterized to empty the bladder, then they have to let the bladder fill again and try to pee. So you can imagine a frustrating and time consuming event. Not too fun for the patient or the nurses.

So here I am hoping to avoid that embarrassment and uncomfortable procedure, and quite hopeful that I won't be one of the statistics.

Oh I wasn't a statistic when it came to the peeing. No...not at all. Not in that category anyhow... I just ended up creating an unique category to begin a statistic on!

I lived up to my "Weird" patient reputation.
Thus I fulfilled the dreams of yet two more Dr.'s who aspire to be a real-life "HOUSE"(referring to the TV character DR)

Once I could feel hot and cold I told the nurses that I felt like something was wrong.
I lifted up the sheets to look down at my legs as they felt wet.
To my horror I was sitting in a puddle of cold wet urine. (collective EEEEEWWWWWWWWW!)
Yet my bladder was full. I cold feel it.
Nurse panic set in. The OH SHIT looked came over 4 nurses and they were on me like flies on honey.
They were in the middle of trickle closing the unit and lots of the nurses were trickling out to end shift and team was suddenly crazy trying to figure out what to do.

Leaking is not normal.
Of course they have to interrogate me to make sure I didn't have a secret incontinence problem I never told them about..... (and at that time I found out if once-in-a-while you sneeze and squirt does not count as incontinence BTW)

Once they realized I did not arrive at the hospital with such an issue, they had to decide how to deal with me. It was then looking like I was being admitted. But as the Dr's and Nurses spoke to me about the problem it seemed they were trying to determine if I was bleeding into my bladder and pushing the urine out, or if the valve was just leaking because it was overly frozen still. The odds leaned toward a bladder fistula and not towards a frozen valve. and there was no way to be certain what was the truth and someone had to make a call on whether I had to go back into surgery or would be given a chance to thaw a bit more and see what happens.

Time passed and the unit emptied out except for myself and another patient who was extremely ill. Once there was no one around, and just before the second last phase of nurses left I negotiated with them to try one thing. I told them that my bladder felt full and that my legs felt like I could walk so now the other patients were gone and we would not freak everyone else out if I leaked all the way to the bathroom, could I try to void and see what happens? The Nurse flipped me back up on the bed and grabbed a portable ultra sound and determined there was 700cc of urine in my bladder which was really full. So the nurses said they would try it, eventhough we could potentially slip. The Dr. gave permission and we tried it. I went really slow so no one would step in wet. I got to the toilet and sat down and they just left me to relax there a bit to see what would happen......

At first it was like a leak. I could not really feel anything there. Then the trickle became a stream and I tried to stop the stream and I was successful! I then keggled my way through it all and emptied my bladder. Yeah!
The nurses were so excited!
Then they had to try to get the Dr. back out of the OR to sign me out.

Around 8 PM on Wed I got signed out. I had successfully voided three times with complete control and was no longer a leaky sieve.
It was decided by the Dr. that my bladder was still frozen by anesthetic and was so full it leaked.
They said my bladder is the size of a child's and 700cc is over full for a child.
Peeing if you sneeze is called stress incontinence and it doesn't count as a concern for Drs.

I have lots and lots of dissolving stitches from two surgical procedures done at once. I had a vulvectomy removal of the labia right side to excise VIN3, plus the marsupialization of a Bartholin Gland cyst( they turn the gland inside out and leave it to the body to take care of it)

Now the Bartholin Gland issue is probably related the glandular cysts caused by my Sjogrens disease(which is a connective tissue arthritis that kills glands in the whole body and connective tissue). Also the susceptibility to VIN3 mutations is caused by a combo of genetics and the Sjogrens tissue disorder. The Dr said even though it took almost 20 years for this cancer to return on me, the chances of reoccurrence is more likely now, but the nature of this cancer is that is best to just use due diligence to eyeball the area rather than to put a patient through chemo and radiation as a preventative. He said that they litterally know so little about this "old women's" cancer, because it is fairly rare, that they cannot even determine if women get these mutations often and seek no help because they have no symptoms and it is possible their cells die off before they become malignant- thus taking care of themselves before anyone even knows it happens/OR/....This is surmized by the Dr's because they cannot explain the low 1st occurrance rate of this cancer any other way except to predict it could have two directions it goes - one: that takes care of itself and folks are none-the-wiser and two: the kind that begins to flourish and becomes a problem and symptomatic, and then it spreads fast and it's too late....

So I was a weird interesting surgery that a Dr. might not get to see too often.....apparently...and the anesthesiologist got to see the fancy part of the procedure right along side the surgeon.
I guess folks don't get to be a viewing guest on this surgery much because it is usually embarrassed old ladies going through it, and a surgeon could not make a spectacle of an old lady.
Us middle aged women have no pride once we had to deliver our babies.LOL And we still remember what it is like to have someone interested in our crotch (blushing LOL and a giggle)

I just told the surgeon that if he was going to dig for buried treasure down there I wanted 20% of the booty!

So I am home. I had a comfortable night. I slept well and didn't pee the bed! :)
I am a little stiff in the lower back from the spinal and I am feeling a bit of rubbing on the stitches but otherwise I am good.
I had to put Poloysporin cream on the stitches and there are I think like 30 and 20 stitches.... on the two sites. It feels like I had fancy plastic surgery down there. So I think that once it heals it will look normal and feel normal.

I feel like I am rambling on a bit when I talk. Al told me I texted him last night and I actually texted slurred LOL. I remember sitting in the bathroom texting him. So today I looked at the text....LOL It was hilarious!
Here it is....and I quote: " Al sorry i didnt call you back,forgot. Pain pills kicked in If u happen to b awake text m and you can cAll cuz ev awakw here othrwz cal when u get a chance tmrrow"

I stayed on the top floor of the house today. I thought it would be stupid to try the stairs. I feel like I am under the influence still, so I will just chill.......

Overall it was a positive experience. I would recommend to anyone to take a spinal for any surgery you can possibly do awake. It is much safer all around and you feel really good after. There is no sudden pain issue with it either which make me think the sudden awareness causes sudden pain as a symptom of the sudden part of the experience. You also get a real appreciation for the folks working in recovery when you are that aware......

So I will definitely be having a cystascope on my bladder in the new year now. They will do it to scan the bladder and urethra for VIN3 patches and to see if there is a mechanical valve issue to deal with.

I think I need to make a big deal out of New Years this year. I think I need to really boot 2009 on its ass and out the door and welcome 2010 with Whoot(tee hee) and a holler!
I want this surgery to be the turning point. I refuse to have two years like 2009! I absolutely refuse!

1 comment:

zingtrial said...

“New day, new blessings. Don’t let yesterday’s failures ruin the beauty of today. Blessings of God are new every morning. Today has its own promise of love, forgiveness, joy and success.Happy New Year!”