Saturday, August 7, 2010

Recovery Journal - Part I

My laparoscopic bilateral salpingo-oophorectomy and laparoscopically assisted vaginal hysterectomy were two days ago. According to my doctors, everything went "perfectly." My team of doctors included a gynecologic oncologist and my regular ob/gyn who delivered my babies. Dr. Mandel has been by regular gynecologist for more than 20 years; he delivered both of my children; and he is the person who first suggested that I consider BRCA testing because of my family history. Since I tested positive, he has been an integral part of my health care team and has done much of my screening, including seeing me at the last minute over his lunch hour on a Friday afternoon because I had been having abdominal issues that worried me. "Come on in now and we will do an ultrasound so you don't worry all weekend," he said. Even though I decided that my surgery should primarily be done by a gynecologic oncologist because of the small but not insignificant risk of finding a small ovarian or fallopian tube cancer during the surgery, I was thrilled when he agreed to be on hand to assist. He held my hand and reassured me in the pre-op room and helped me onto the operating table in the OR. His was the last face I saw before the anesthesiologist put me under.

Some gynecologists feel threatened when a high-risk woman seeks to have preventive surgery with a gynecologic oncologist because gynecologic surgery is a routine part of their practice. But because prophylactic surgery in a BRCA-positive woman can turn up an otherwise undetected small cancer about five percent of the time, my personal feeling was that this was significant enough to warrant having the surgery done by a cancer expert, a gynecologic oncologist. I feel lucky that my regular gynecologist and my gynecologic oncologist were happy to work together on my care. I recognize that not all doctors put aside ego to the put the needs and desires of the patient first, but my team clearly did, and my experience was less stressful because of it. In the pre-op room my anesthesiologist said I was one of the most calm patients he had ever had. My blood pressure was low, my heart rate was low, I was calm and I had no anxiety whasoever. I was at peace with my decision and I was totally comfortable that I was in both expert hands and caring hands. Going into surgery with someone with whom I had a 20-year relationship meant that I knew Dr. Mandel would take good care of me. I found this deeply comforting.


I awoke in post-op shivering, just as I had after my mastectomies, which is my body's reaction to both pain and anesthesia. I really was not in that much pain (from what I can recall through the narcotic haze) so it was probably mostly the post-anesthesia reaction. Nonetheless, my nurse put the familiar green pain medication pump into my hand and instructed me to push the button, which I did. I dozed on and off over the next hour with my nurse waking me to remind me to push the pain medication button pretty frequently. The pain was so much less than the post-mastectomy pain that I did not feel like I needed as much pain medication but I obediently followed her instructions whenever prompted.

One of the surprises in the recovery room is that one my my nurses was Joi, spelled exactly the same way as my name. I think she is the first person I have ever met with the same name.

I recall my gynecologic oncologist visiting me in the recovery room and telling me that the surgery had gone perfectly and that from his perspective, it was "textbook." My final pathology report will be ready in about a week and am hopeful that it will not contain any surprises.

I spent one night in the hospital and am glad that I did. I know some women who do go home the same day after a laparoscopically assisted vaginal hysterectomy but for me I am not sure I could have handled oral pain meds right away so I was glad to be in the hospital with the IV pain meds the first 24 hours.

My surgery was at 7:15 a.m. and my doctors did not allow me to have anything to eat or drink until dinner, when I was allowed only clear liquids: broth, tea, jello. To my surprise my digestive system did not react well to dinner, and even though it was all liquids it created a lot of digestive gas, which significantly increased my pain. The day after my surgery I was up early for my first "walk," which only involved a shuffle to the nurse's station and back but by mid morning I was gradually being unhooked from the medical technology in my room in preparation for going home.

My only hospital visitor was Ora, my wonderful co-author and friend who brought a beautiful bouquet of roses that were admired by everyone who entered my room.

By lunchtime my nurse unhooked my IV pain meds and brought me applesauce. Unfortunately I fell asleep before taking my first oral pain medication and woke in significant pain. The first dose of oral pain meds (Percocet) failed to bring my pain under control and I found myself once again shivering uncontrollably, which only made the pain worse. My nurse brought a second dose about half an hour after the first one and by a little more than an hour after I awoke the pain was back under control, but it was a long hour.

We timed our trip home in the afternoon so that we left the hospital shortly after a dose of pain medication to make the trip home as tolerable as possible and I had brought along a pillow for the car ride to keep the seat belt from irritating my abdomen. Typical Friday afternoon LA traffic meant that we meandered along at a snail's pace, which was actually OK with me. Car travel when I am taking narcotics tends to make me carsick but we never went fast enough for that to be an issue. It was nice to get home and crawl into my own bed. It was also good to get into my own shower and come out clean!

Today I am just more than 48 hours post-surgery and I am already feeling better. The more I get out of bed and move around the better. It seems to help move the gas around. My pain today is under control with minimal narcotics. Prescription strength ibuprofen seems to manage most of the pain. Today is better than yesterday, and I expect that I will continue to improve at a relatively steady rate.

I will keep you posted!

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1 comment:

  1. hey joi!

    great update. i hope you continue to rest well.