Recovery from Laparotomy

[Grandmere68]

Hi,
I was scheduled to have a 10x10cm "suspicious mass" removed from the right ovary on March 10th.  But lucky me, I went to the hospital last Thursday for my pre-op stuff, and by the weekend I have a blooming case of flu.  So surgery postponed for another two weeks.  I have never had such a violent cough in my 68 years, and am hoping my ribs are no longer sore in time for the surgery.  

I find the information on this forum helpful in planning for recovery.  

I will have help (my daughter for a few days and my husband all the time) and I am retired.  

Does anyone have any special advice?  Have had laparascopic gall bladder surgery and vaginal hyst. but never open abdominal surgery.  All suggestions will be appreciated.  My CA-125 is 25.  

Truth be told, I am one scared cookie.

Thanks in advance.

Grandmere

[Grandmere68]

Thanks for the tip about the shower stool.  Great idea.  A family member has one I can borrow, I know.   I'm drinking vitamin water now to build strength for the surgery.  The doctor changed my meds yesterday when she heard me wheezing.  Now I feel like I will be stronger for the surgery set for about a week and a half.  I think I'll ask my hubby for a new robe.  Mine zips and has to go over your head.  Sounds like too much trouble to me.  Thanks again for the help and good ideas.  Knowledge is power.

grandmere

[TrudieC]

Hi there.  I responded on the spinal question in your other posting.  MarieMichele did a good job of describing.  I'm in Canada so a wee bit different.  With the spinal they will test you with a balloon full of ice to see how you feel it.  This determines how well the spinal is holding.  I stayed in the hospital gowns and just brought my robe and slippers.  With the spinal you will get a bit more attention after your surgery.  Ensure you get a sleeping pill at night.  Once you are home I found it useful to have a stool ready to place in the shower so you can sit down.  Initially you will feel weak and perhaps unsteady on your feet.  You will tire very easily so better to be safe.  When you are home make sure you have some GasX or Ovol for gas (mint tea is good too), that you drink lots and lots of water and that you do nothing for the first 2 weeks but walking around your home to relieve the gas and regain your strength.  Get all the healing rest you can.  Good luck!

[Grandmere68]

Ah, yes.  I think they call it dermabond, or something close.  My husband had surgery in November with that closure.  He has a very very slender line.  It's amazing.  

But when I asked what they'd use on me, I was told, staples.  Oh well.  

Thanks again for all your help.  It counts.  Now if I can just stop coughing...

[MarieMichele]

To answer your question, yes, my surgery was very recently:  January 16, 2009.  The memory of the hospital experience is still very vivid so this is a great time for me to document it for others.

My incision was closed in a unique way.  Not sure others will have this, but wanted to share.

No staples!  Stitches were all internal and the exterior was glued together with skin bonding glue.  It all dissolved or peeled off on its own with no assistance from me.  No followup visit to the doctor to remove stitches or staples.  I only had a followup for him to check on how I healed.  No seepage/drainage or ickiness as far as the incision/scar is concerned.  When they took off the surgical dressing (just rectangular gauze with tape around the borders), The incision was all dry and clean and remained that way.  What a great way of doing things.  I was very impressed.

[Grandmere68]

Regarding clothes, etc. after the fact, I still have my jumpers I wore following my lap gall bladder surgery years ago.  Couldn't stand anything on my belly button for months!   Hadn't thought about drawstring clothes.  I think that's a good idea.  

I'm not sure underwear is made that is big enough to cover my butt and reach over my belly but I'll look into it.  I thought I'd have to wear bikini stuff, which I hate.  

This forum is a wonderful thing.  It helps dissolve a lot of the fear.

Thanks.

[Grandmere68]

Thank you so much, Marie Michele.  

I had actually been to the hospital for all the pre-op stuff before I got sick.  I think that's where I got it, and it is the nastiest flu/cold whatever that I've had, and have never coughed and wheezed like this.  

But, when I spoke with the anesthesiologist, he offered me a choice of either IV drugs (what I've had before) or a spinal.  They also put you to sleep with the spinal.  For some reason, they like it better.  He said they stay ahead of your pain with the spinal rather than catchup.  

Does anyone have an opinion on this.  I said, okay to the spinal, but since I have so much "lead time" (ha!) I could probably change my mind.  I am sensitive/allergic to codeine and demerol (I barf them right back) so they're never an option for me.  

I certainly appreciate this forum, and especially thank you Marie Michele.  You just had your surgery recently, didn't you?

grandmere

[MarieMichele]

Things I left out from above:

1. IV port will be in your hand the entire stay, even when you are no longer getting IV.  They remove it just prior to discharge.

2.  When in the paper gown, they also may give you non-skid socks to wear.  You'll be in a bed with a sheet to cover you in the first staging area, second staging area, etc., so you're covered up and plenty warm/comfy.

3.  Gas pains post-op can be worse than the incision/surgery pains.  They'll give you chewable medicine for the gas and don't be shy to ask for it.  Doesn't really help much, though.  Walking, walking, walking is what moves the gas out.....but you won't have your strength back to walk that much yet.  Walking will get you out of the hospital faster, because they need to know you can pass out the gas.  Anesthesia paralyzes the digestive system and they have to know it is working again.

4.  Absolutely DO NOT eat or drink anything after whatever hour they tell you prior to surgery.  Not following this order can be fatal (because of the digestive paralysis caused by anesthesia).

[MarieMichele]

You definitely don't want to have this surgery until the cough subsides.  Coughing, sneezing, laughing...they all hurt terribly in the first two weeks or so following the surgery since they involve the ab muscles.

The surgery is over in a blink.  I'll relay my own laparotomy experience step by step.  I'll use the word "you" here, but it really means "me".  Chances are your experience will be similar.

The day before, it's the awful laxative process and you'll start that day on a clear liquid diet only.  They may have you wash with a disinfecting soap the night before and the morinig of the surgery (at home).

Upon arrival to the hospital, they have you remove every stitch of clothing (they tell you don't arrive wearing jewelry, makeup, lotions, powders, deodorants, etc.) and you'll have to remove eyeglasses, and give to your husband to hold for you.  You'll be put in a hospital gown (mine was made of paper).  You may be given a blood thinner (injection to the thigh).  Then you go from the first staging area to the second one.

Here they put an IV line, most likely into the back of one of your hands, you get to meet the surgeon and anesthesia staff and talk about a variety of issues.  At some point, they put you to sleep (I didn't even know they had started that process), and in another blink you're waking up in recovery.  No memory of what occurred or awareness of how much time has passed.

When you wake up, you will be connected to a urinary catheter.  It won't be comfy (don't fidget and it will be fine).  You'll be glad to have this since you're not ready to move and walk to pee just yet.  Still on IV.  They may have oxygen tube resting at your nose (not IN your nose).  They will move you in the bed to your hospital room and out of recovery.  Surprisingly, you woke up in a cloth hospital gown. Paper one is gone.

They'll add a morphine pump (self-dosing) to your IV once in your room.  Follow the digital display once you are alert enough and it will tell you when another dosage is available.  Push the dosage button (it will be on a wire and close to you like a wired remote control).  Do it every time a dosage is available. You can't overdose.  It won't allow it.  They will probably give you two full syringes worth.  One empties, they'll replace it with a second.  After that, they may stop morphine and switch you to painkiller pills, like a codeine/tylenol pill.  Stay ahead of the pain, at least in those first few days by staying on schedule with the meds.

You'll probably be awake all night that first night in the hospital.  Something about the anesthesia.  Nothing will taste right for days, but you'll still be on a liquid diet for Day 1/Night 1.  Oxygen may be taken away that first night (it only annoyed me and made my nose itchy).  

They may either put stockings or inflatable leg stimulators (feels like a blood pressure device that inflates and deflates ALL NIGHT LONG) on your legs to prevent blood clots while you are still bedridden.

They'll want you to breathe several breaths into a device that helps clear your lungs from the anesthesia and prevent pneumonia.  Will have to do this regularly, like every hour.

The next day (Day 2) they may up you to clear foods plus liquids like jell-o, sherbert, and a variety of clear drinks.  Urine catheter gets removed. (now you have to walk to pee!)

That first move out of bed won't be fun.  They'll teach you to roll out of bed, holding a pillow to your stomach.  Getting back in bed is not fun either, but you learn the least painful technique pretty quickly.

Pack a small suitcase with:
1.  A comfortable robe that covers you well.  They'll insist on getting you to walk the day after surgery and you'll still be in that awful hospital gown.  
2.  Bring your own slippers (non-skid soles only...those floors are too smooth for anything else).
3.  If you want out of that backless hospital gown, bring your own comfy nightgown (not too long since bathroom trips are going to be challenging).  You don't want anything with elastic around the waist just yet so PJ bottoms really don't work at this point.  You won't be able to wear this until the IV is removed, though, at least not without nurse assistance.
4. The hospital may provide some type of stretchy panties, but bring your own supply as well.  Panties....oversized is better, with a high waist (far from the incision line).
5.  Not sure if you'll need it or not, but sanitary napkins (NO WINGS) are good to have, just in case.  If not, hospital will supply if needed.
6.  Bring an electric razor if you want to shave (anything but the private areas) while in the hospital.  They won't want you using razor blades because of the risk for cuts/infections.  They may try to talk you into an assisted shower Day 2, but I opted to sponge bath myself whenever I worked up the ability to walk for a pee.  The idea of trying to move for a shower was too much.
7. They may keep you in stockings the whole visit, but if not, warm socks should be in the suitcase.
8.  Bring makeup, deodorant, soap, toothbrush, toothpaste.  They'll supply soap, toothbrush/paste, shampoo (small stuff like in a hotel), but you'll probably want your own stuff.
9. Bring something to read.  The TV channels in your room probably won't be very exciting.  Although it may be hard to concentrate while still on pain meds.
10. Bring something comfortable to wear for the ride home that does not put pressure on you from the waist down and from the hips up.  Loose elastic or draw string pants are good, or a dress.

During Day 3, they are going to be hoping you pass gas, have a bowel movement (may occur in Day 2, in fact).  You won't be discharged until these grand events occur.  Morphine pump #2 will be empty and you'll be on pills now.  Surgical dressings may be removed at some point (Day 2, possible) and incision will be exposed/uncovered.  

If you pass gas, they'll put you on solid food.  Passing gas and bathroom movements must be done cautiously.  The muscles you use to go to the bathroom are all inflamed and sore and affect your incision/stiches if you strain.

I went home the morning of Day 4.  Could probably have gone during Night 3, but it was a Sunday.

For the drive home.....make sure there's a small pillow in the car.  You'll want it for your cautious roll into the seat and to hold to you for the drive home.  You can use the seatbelt, but put it over the pillow.

At home, the worst part is learning how to get in and out of bed.  I was more comfy on a couch with a lot of pillows around me during the day, but still moved to the bed at night.  Someone will have to do most of everything else for you, especially where it requires lifting 5+ pounds.  You'll be discharged with prescriptions for pain killers.  Use them, but if you can..ween off them quickly, it will prevent constipation, because you do not want to strain.

Follow the post-op instructions they give you about what you can do/not do in the next week, two weeks, etc.

You'll be sore, but so relieved to have the surgery behind you, you'll hardly notice.

Don't be scared. This is pretty routine for the doctors/hospital.  It's a major event for you, though, because it's a first.  It was for me, too, and I'm the biggest medical coward I know.
Best wishes to you!