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Suzy's Big O-O

Jun 14, 2008 - 1 comments
Tags:

ovarian cyst

,

laparotomy

,

postmenopausal

,

hysterectomy



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Background: It all started way back at the turn of the century—in 2000, I was diagnosed with a uterine polyp after a bout of heavy bleeding (Is polyp the “new” term for tumor? There are polyps everywhere these days.). My doctor even tried to remove the polyp then, but there was a problem due to my “tipped” uterus. So in 2008, I still had the polyp. I have also been on and off HRT, and at times, had heavy periods.  But the lack of hot flashes made HRT and the heavy periods worth it, in spite of the warnings in recent years.

Fast Forward to April 2008:  I went for my annual checkup and reported that I was still having heavy periods. This time I was seeing a different PA that works with my GYN and she was concerned about the periods given my advanced age (59) and postmenopausal status. That led to a sonogram of my uterus to see what the polyp was up to.

During the sonogram, they found, not only the polyp, but also a baseball-sized black hole that was identified as an ovarian cyst. The polyp was about the same as before, but the cyst was a newer development. It was a fluid-filled sac “with sections” that was termed a “complex cyst.”  There was no telling how long it had been there, or what its status was. At the follow-up visit with my doctor, she told me that she recommended removal of the ovaries (an oopherectomy, the Big O-O) as well as a hysterectomy to remove the uterus. The cervix was up to me.

There were several options and combinations of surgeries possible. Since the other ovary was not affected, theoretically, that could stay. However, given the chances of future cysts and ovarian cancer, the decision to remove both ovaries was easy. The uterus also was an easy decision because: 1) the future cancer risk which was somewhat higher due to the polyp, 2) the convenience--since we were already going in, might as well take care of everything at once, 3) eliminating the need to take progesterone with estrogen (a big plus to anyone who ever took those), and 4) no periods (yea!). I was still undecided about what to do with the cervix.

Both my mother and sister had their hysterectomies years ago. I thought I was lucky since I had escaped that need. My sister was very upset after her operation due to the scaring and removal of her ovaries and cervix which were not even discussed with her beforehand. She did not have the choices and risks presented as I had, and she was surprised and dismayed to find out afterward what her doctor had decided for her, especially since her oopherectomy was not necessary. Not only did my doctor present the medical issues, but we also discussed the surgical approach and type of scar. I agreed that a vertical scar was best for me, since laparoscopy was not an option due to the risk of rupturing the cyst. Also, there was a higher risk of ovarian cancer since I am past the age where benign ovarian cysts are a common occurrence.  

My doctor would have a GYN oncologist on call in the event that the abdomen showed visible signs of cancer or the frozen section biopsies done during the operation revealed cancer. In that case, they would wait for the oncology specialist to come and remove the cancerous areas before closing. The oncologist would need to make a larger vertical incision to make sure all areas were clear. In that case, I could end up with an anchor-shaped scar going both ways. This, I really did not want. I was already very concerned about cutting through my abdominal muscles (or what there was of them since I am not in my best shape ever).

That leads to the other issue—THE SCAR. While I am a widow, I still harbor dreams that someday, I would have a romantic relationship again. My body may not be the sexiest thing, but with a big ole vertical stripe that looks like someone was making a ruched pillow out of my stomach, it could get a lot worse. Self confidence in that area has never been a strong point for me. I think I worried about this almost as much as the cancer risk. I dreamt of getting Smartlipo beforehand, losing 20 lbs in one month through exercise, all those things that I knew would not happen. For a brief period, I even considered getting a facelift—maybe I could keep the focus above the waist?? Eventually, I came to terms with the fact that my appearance was not the most important thing here. Getting past the surgery and back on my feet was the real goal, even if that meant a pleated stomach—after all, they now have Spanx, right?

Pre-Surgery: As I approached the day, all the decisions except the cervix were made, all the blood tests taken (or so I thought), the pre-op visits and pre-surgical check-ins done, and I was finally ready, but feeling very nervous. What had I forgotten? Who should be contacted? Did everyone know what they should be doing at work? Don’t forget the medical directives and medical powers of attorney to put in my hospital files, etc. I checked off the items to put in my hospital bag. I didn’t know how long it would take in the hospital (2 or 3 days), and I have never been a light packer, I prepared for the worst. My 85-year old mom could barely lift it once I was done.

Things I packed that I actually used included toothbrush and toothpaste, house shoes (for walking the halls), zip-up robe (something easy to put on for hall walking), shampoo and conditioner (needed to take a shower to remove my outer bandage from surgery so I also washed my hair with nurse’s assistance), antiperspirant, comb and brush, hand mirror. I wore the same clothes home as I arrived in. I did not wear any of the gowns I brought since the hospital gowns were more convenient. Also, I was not comfortable in my underwear so I didn’t wear that either. The hospital provided booties, but I didn’t want to walk outside my room and then get into bed with the same booties on.

O-O Day: The day of surgery, my mother and I arrived 2 hours ahead of time as instructed. I thought all the paperwork and labs were done, but we had to do even more. I gave them the legal papers I brought with me, just in case. Hysterectomy is not considered to be that risky, especially since so many of them are conducted in the US every day. It is one of the most common of all surgeries. However, things can and do go wrong. My husband Randy’s first wife had died following a hysterectomy, so that was always in the back of my mind. They never knew exactly what happened, but attributed it to a brain aneurism. Since no autopsy was done, it is still a mystery.

Note to self: remember to tell someone—always do an autopsy if there is any doubt—in the long run, it is more comforting to loved ones to know what happened.   It could be something they need to be cautious of or they may even be thinking that they are the cause. Knowing for sure removes that question and self recriminations.  For example, when my husband died, it was very helpful for me to know that we did everything possible and that it was not something he or we could have prevented.

They took us to a small room to meet with the surgical nurse, the anesthesiologist, and my gynecologist before the surgery. The nurse put in an IV line, and I think I got a pill for anxiety because this part on is pretty fuzzy. I do remember my doctor coming in and asking if I decided about the cervix. I had discussed it with my mom and decided to go ahead and remove it. That way, I would not have to worry about cervical cancer. My mom said she wished she had done that because it was always something she worried about.

I barely remember being wheeled down the hall to surgery. The next thing, it was about 3 hours later and I was being wheeled into my hospital room. I was thinking, “this isn’t so bad, I don’t hurt that much. I must be on some good pain medicine.”  I was hooked up to an automatic dispenser that provided a constant flow of the meds and released an extra amount when I pressed a button.  My mom brought in all my stuff and we settled in. My son and daughter came to see me, bringing flowers and gifts. I don’t remember much from this time except that I could only have ice chips and I didn’t have to get up because there was a catheter. I was just glad not to be nauseous which would have really hurt. When I had my gall bladder removed, I was given Demerol and throwing up was the worst thing you could imagine. This time, I had requested no Demerol and thankfully, I had no throwing up. I couldn’t tell that the Demerol had made a difference other than that.

O-O plus 1: The next day I was still on a liquid diet, but that was changed after they removed the IV. It was good not to be tethered to the bed, but I really missed the pain killer meds. I thought I was doing so great until I tried the pain pills and discovered what they really meant by a pain level of “10.”  I did learn to “stay on top of the pain medications” because if you waited, it was a lot harder to stop the pain than to prevent it. The nurse told me that I needed to ask for it—they wouldn’t just come in and give it to me unless I asked for it. That was weird to me, and I felt like a hypochondriac, but I figured out that it had to be done or I would pay the price.  So every 4 hours, I called the nurse and asked for it. Even tho the prescription said every 4-6 hours, sometimes they were busy, so ask at 4 and don’t let it go past 5. After all, those first few days in the hospital are your time to start healing—no need to be a martyr or to show how tough you are. Your body will thank you later.

Walking is a big deal. Every other sentence started with “have you walked yet?” I found myself not wanting to disappoint them, so I would walk slowly and cautiously around the nurses’s station. This initiated the second phase of recovery—gas elimination. The more you walk, the more you get rid of the gas, the less pain you feel. Okay, got it.

O-O plus 2: Shower day. I had a big gauze bandage over the incision and my doctor said it would be easier to remove in the shower. The nurse helped me and we soaked it off. I made sure the pain meds had kicked in and went for it. I felt better after washing my hair even though towel dried is not my best look. And now I could see the incision. Oh yes, that is what the hand mirror is for. The little mirrors in the bed tray don’t work for that so you need your own if you are curious as I was. I couldn’t tell much tho. It was held together by tape, looked okay to me. Since the incision did not have to be that large it was about 3 inches long and ended about 3 inches below my navel. That meant the incision part was tight and the abdomen above that seemed swollen and pooched out. I hoped this look did not last and my little belly would go down.

I waited for the doctor to come tell me I could go home. Apparently, bowel sounds figure prominently in that decision. Pain level at about a 2-3. The doctor said I could leave after supper. Mom and I prepared to go. She packed up my stuff and we waited and watched TV. My son came and picked up my stuff and all the flowers and took them back to my house so we would not have to deal with it—very helpful. Eventually, mom drove me home and while I went to bed, she went to pick up the prescriptions at my pharmacy-important to do right away. At last, the end of a long and exciting day.

First day home: I woke up in the middle of the night in a lot of pain. Then, I realized that I needed to take the pain pills.  No one would wake me up to do that, only the pain itself. It wasn’t a 10, just about a 7, but needed to be addressed so I could sleep. Before bed, we had arranged pills, water, and other necessities bedside, but I had to get up to go potty anyway. That was an adventure. As if walking wasn’t bad enough, sitting was even worse. I hobbled back and forth and made it until morning.

Day 2 at home: Warning, the first day home feels great and if your pain is under control, you may overdo. I did. That night, everything hurt. My mom told me that the second day was always the worst—gee, could have used that advice a little earlier. Also, concerns about constipation kick in. I realized it had now been 5 days since anything happened in that region. I started taking the softeners, active yogurt and fiber pills. I didn’t realize that I was setting myself up for a major dam break. More advice, go with one method—and start before you have surgery so your system is used to it—don’t wait until you have major blockage, be preventative, and above all—don’t strain.


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by TrudieC, Jun 15, 2008
Suzy, love your way of describing.  I came home this past Tuesday night after a partial hysterectomy with vertical cut.  Glad to hear you are doing well.  Weird how some days the pain isn't so bad and others where ou just can't get it under control.

Take care,
Trudie

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