The Surgery-Part Three: Surgery

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The Big Day…

I got up early in the morning to get ready for the day of reckoning.  My nerves did start to kick in a bit, and show up in the form of being overbearing, but I was still ready to move forward. That morning (and the day before) I had to wash with an antimicrobial soap called Hibiclens, but no lotion, oils, or creams, so my skin was free of microbes… but I was ashy.

We got the hospital early. Not on purpose, but around DC, you never know what traffic will be like so we left about an hour and a half before I had to be there. The hospital is a 35 minute ride without traffic.  On that day, traffic was light so we got there  about 30 minutes before my  scheduled check in time. My procedure was outpatient, so I didn’t have to pack a bag.

If I could say there was a great part of waiting, it was that one of my best friends, who had surgery to remove fibroids and endometrosis a few years before, called to pray with me. That meant so much and calmed my spirit.

Checking in meant going over all of my personal information, insurance information, and who to contact in case of an emergency. You get asked that all the time, but this time it really sunk in, probably for the first time that something could go wrong. While the chances were slim, it was entirely possible for something to go wrong: A cut too deep, the wrong combination of sedatives, emergency hysterectomy…..anything. DON’T panic or worry over those things. You will think about it, and the closer you get to lying on the table, the more real the possibility becomes, but you’ll be fine!

Finally, I was called to the pre op area, but I could only take one person back with me. I chose my mom. The nurses I had were awesome! They were so friendly, efficient and knowledgeable. Another great part of this prep team: the woman who put in my IV.  Every time I go to a doctor for blood work, or have an IV put in, it’s an ordeal. Every. Single. Time. Bruised arms and multiple sticks are the norm. When I had my wisdom teeth pulled several years ago, they just put the IV through my hand because those veins were easy to see/get to. Every once in a while, I will have someone great at their job. She was one of them. She came in, introduced herself, I gave her the “they always have a hard time” speech, and she said “oh, don’t worry”. She found a spot, put the line in, and I was good to go!

While my nurses were getting me prepped, Dr. M popped in and looked puzzled as to why I was still sitting around talking. (Really, he looked annoyed)  My surgery time was 9:00am, but he was ready to go about 20 minutes early, so they sped up the process of getting me prepped.  He answered any last-minute questions and gave my mom the prescriptions I would need.

A word of advice: Ask any last-minute questions of your doctor the day of OR have a list for your family if the doctor visits while you’re in recovery.

The anesthesiologist came in and put in the juice. I went from slightly on edge to fits of giggles in about 10 seconds. My family (who were all allowed back at that time to see me before I went in) thought this was hilarious and captured the whole thing. Yay smart phones….

 

The next thing I knew,  I was looking at ceiling go by. The sedative was starting to do its job, and I was fading in and out. I remember going into the operating room, and thinking “Wow, there’s a lot of stuff in here”. I remember being lifted on to the actual operating table. I remember the mask being put on my face. He didn’t ask me to count down, just to think about a vacation or being on the beach……..

The next sensation I can remember experiencing: pain.  Awful, horrible pain. And nausea. I will say, that if you’ve had a baby, the post op cramping might not be as bad for you. I  remember saying (I felt like I was yelling, but it was probably a whisper) “I’ve gotta throw up”. Then I did (Reaction to the anesthesia). They gave me something in my IV to help with the pain and the nausea, and I was in and out of sleep for about an hour. I mostly remember being in a sort of limbo state. I could hear people around me, and I was slightly aware that I was moaning from time to time, but I was  woozy and not quite able to move or be 100% present. I remember a  nurse saying she couldn’t give me any more pain meds or it would slow down my breathing, and thinking to myself:  “And?…” Yeah, I was in that much pain.

Finally, I was semi lucid, enough for saltines (maybe they were graham crackers?…) and ginger ale. I was still very woozy, but more aware of my surroundings and better able to communicate.  I couldn’t speak loudly because I was intubated (breathing tube) during the surgery. Because you will be put under deep sedation, you’ll have a breathing tube inserted. When it’s out, it leaves your throat very scratchy for a few days.  After I was “up” (and I use that term very loosely), they moved me to phase 2 of post op.

Phase 2 is where they let you rest a bit more in one of those hospital reclining chairs. By then, I was un-hooked from all of the heart monitors, but I think I still had an IV. I still had a bit of nausea, but they said I was OK to go home.   In the hospital, they give you these  polyester/mesh hospital panties with a pad. They’re not  sexy, but they were surprisingly comfortable! They’re like high-waisted boy shorts, perfect to not rub your incision and/or laprascope port areas. You will have some bleeding that day, and you probably won’t be lucid enough to put in your own pad, so just rock the hospital panties home. Trust me. In fact, I wish I had asked to take a few pair home.  Because I was still feeling nauseous,  the nurse gave me a few of those blue “barf bags” and alcohol pads. He said taking a whiff of the alcohol pad can sometimes calm the nausea.

I will say my only critique of my surgical process and the hospital was I felt like they were rushing me out. I really think I could have stayed another hour resting OR actually stayed overnight.

In my wheelchair, nodding off, they were finally ready to discharge me. The nurse gave  my mom after care instructions, signed something, and they took me down to the lobby. O and my dad were there with the truck and helped me in. I tried to put my own seat back and went back to far….bad choice. With no abdominal control, that sudden flop of the car seat was a pain I’ll never forget.  Don’t try to do anything for yourself the first 72 hours at least.

 

Day Of Take Aways:

  • Have an emergency plan, make sure your family knows your wishes (the hospital will ask you about those things)
  • Have a final list of questions for your doctor. Ask your nurses and anesthesiologist questions too
  • Be kind to your nurses!
  • There will be pain post op
  • Take home the hospital panties. (Thank me later)
  • Don’t try to boss your family around and insist you can do things your self 2 hours after surgery with anesthesia still in your system.

The Surgery-Part Two: Preparation

The decision has been made: remove my fibroids.

Prior to this, I had never had any type of surgery or extended hospital stay. I wasn’t really sure what to expect. I thought I’d just make the appointment, take time off and go in. I was very wrong. There was a lot that needed to be handled before I went in. In the month leading up to the surgery, I had a lot to do.

I was very wrong.

Time off from Work

Well, I definitely did not think this step was going to be as involved as it was. I had only been on my job six months at that point, so my paid leave was scarce. I had 5 days of vacation and 5 days of personal/sick time. problem was, I would be out at least 4 weeks, maybe more. The solution was to put in for a leave of absence, where at that point I would earn a portion of my pay. I should also say that I work for a mid size non profit, and its not extremely bureaucratic or formal all of the time, but obviously this had to be. I should also point out that my Deputy Director, also a Black woman, had several myomectomies and knew exactly what I was going through. The fact that she understood what was happening to me and the recovery process was very comforting to me. It was easy for me to tell her what was happening. On the other hand, my manager, (who was awesome and I had a great working relationship with) was a man, so it was a bit more awkward explaining to him what kind of surgery it was, even in vague detail. I also had to present a note from the doctor to verify that I would be having surgery and would need time to recover/recuperate. Make sure you get all of the proper documentation from your doctor’s office

In the end, I worked out the 5 weeks using all the sick and vacation leave I had, then using leave of absence and a week working from home.

  • Read up and talk to your HR department about your extended leave options and time off. Depending on the method of surgery, your time off could be 1-6 weeks.
  • If your job offers telecommuting, I suggest using this option for a week or two before you head back into the office. It gives you a chance to catch up on what you missed without getting too stressed out, and you can still lay or sit in a way that will be comfortable for you, make any follow up visits, and maybe get a nap in. You will need naps as you recover.

Insurance

Hopefully you’re going through this with at least some health insurance. If not, it can cost you. But just because you have insurance, it doesn’t mean they will cover everything. Call your insurance company and see what is covered exactly. Also call the hospital where you will have your surgery to see how they bill. See what you will be responsible for out of pocket, co pays or other fees. Particularly for the Anesthesiologist.

Believe it or not, the anesthesiologist is not always covered with the doctor. You would think they come as a package deal, like a cable/internet bundle but, wrong again! The hospital often bills for the anesthesiologist separate. Speak with hospital billing and ask who/what practice they use and see if your insurance covers that individual/group of anesthesiologists, AND how they bill.

Fortunately for me, I had excellent health insurance and my surgery costs were covered. The rep I spoke to said I may have a $40 or $50 co pay the day of. Bless the Lord, I didn’t even have that. The hospital billed my insurance for the anesthesiologist in a way that their costs were also covered. Won’t HE do it?!

Physical and Blood Work

Your doctor will probably have you to get a general physical from your Primary Care doctor just to verify that your are in general good health and OK to be put under anesthesia and have surgery. They will also request blood work, but that in my case had to only be done within a certain window leading up to surgery. I think it was 7-10 days. The doctor/lab performing these will send the information back to your doctor.

Support

This is probably the biggest thing to have in order: Who will help you while you recover? Again, depending on the method and your particular situation, you could be down for a while.

At the time, I lived in a 1 bedroom apartment. Its was a nice size for me, but all the people who wanted to come help and wanted to stay with me was the issue. Of course O would be around, but he didn’t need to stay, he lived close by. My Mom was coming, of course, and my Dad insisted on coming. My parents are not together, but they get along, but I was still worried about awkwardness in close quarters. Neither of them was going to stay in a hotel 1)because neither of them had a bunch of extra money for a hotel 2) They both felt their 24 hr help was necessary.

My Mom stayed for about two weeks, my Dad only stayed the weekend, which was perfect. I had two couches and an air mattress, so I figured everyone would be OK for those few days.

House work

Its a small thing, but the last few days before your surgery, tidy up your apartment/house. You might not be able to for a while. Also, if you have people staying to help take care of you post surgery, hit up the grocery store so they have meals and snacks. Also, pick up soup, jello, crackers, cereal for yourself. Those are about the only things you’ll be up to eating the first few days.

Now that you’ve got your help lined up, your insurance coverage confirmed, your time off approved and your out of office responder is on. You’ve prayed, you’ve shopped, you’ve done all of your last minute running around. Its the day before the surgery. They probably have you to…

Cleanse

…and not your palette! Also known as a “bowel prep”. Because they will be operating so close to your bowel and bladder, they prefer that they are as empty as possible. I’m not going to lie to you, it sounds innocuous on paper when they give you the detailed instructions. Just a little milk of magnesia, dulcolax and a liquid diet after 12 noon. I had never been so wrong. In real life, its so, so much more.

Stomach Problems

You’ll start this all the day before your procedure. If you can work from home, or take part or the whole day off, it would be wise. You can eat solid food for breakfast. I don’t do a heavy breakfast. Trust me. They usually suggest toast, cereal, yogurt, fruit. etc. I think I had toast, turkey bacon and orange juice.

At noon, you take a large dose of milk of magnesia. Now you’re only on water and clear liquid like jello or broth. Several hours later, you take another dose of MOM with 2 Dulcolax (or similar) pills. I think you can see where this is headed…. It comes in waves and will last you well into the morning.

6-12 hours before surgery, you can’t even have water.

Now you’re insides are all clean and you’re ready to go in.

On the emotional side, I was pretty steady. I prayed very diligently about healing. I prayed for my doctor and his team every day the week of . No matter what your spiritual or religious beliefs are, this, I think is the most important prep work. Pray, meditate, read scriptures, whatever gets you closer to God and calms your spirit. I wasn’t afraid at all. Maybe because I knew it had to be done. I also didn’t look at this as the major surgery that it is. I just kept saying “Its not like I’m having open heart surgery or anything” The truth is this is a major thing, even if it is fairly common. I was touched that so many people offered to help and support me. I felt loved, which is always a great feeling. I also think I was so distracted planning and prepping, I didn’t really have time to think about all that was going on, until the day of.

The Surgery-Part One: Making the Decision

I’m going to break this down in to parts because, it really does happen in parts: The decision, the prep work, the actual surgery, and  recovery. This would be the longest, most boring blog ever if I did it all at once. Plus, everyone loves a good cliff hanger.

If you are anywhere in the myomectomy process, I hope these posts can be a guide for getting through and what to expect.

 

I went to my doctor for a consult after she had the opportunity to review the ultrasound images. I had fluid on my kidney, several fibroids all around my uterus, including one in the back of my uterus that “died” (the blood flow cut off), which is what caused my lower back pain. Basically, my uterus was like a big ol’ bag of marbles. Well, a small sack stuffed with marbles? She couldn’t say how long they’d been growing, since no other doctor had made me aware of them. She couldn’t tell me how fast they grew, for the same reason.  She spoke with me about my options: Just “wait and see” since they weren’t causing too many symptoms (mainly heavy bleeding), or get them removed. Since I wanted to have children, she didn’t recommend UAE (Uterine Fibroid Embolization). Her recommendation was to get them removed because I wanted to have children but mainly because of the fluid on my kidney. Her concern was that there could be issues with my kidneys that could become serious. Little did she know, I had pretty much made up my mind on day one that these suckers had to go. She did not have to convince me to have surgery.

After the ultrasound and the consult, my GYN referred me to a surgeon. My doctor is awesome, but doesn’t do any thing but examinations /basic gynecological services and tests. No baby delivery. No surgeries. Just exams. Which I guess other doctors in the area love, because she gives them a lot of referrals and a lot of business.

She referred me to a doctor who is one of the best in the field: Dr. M. He is tops in my region (Washington DC area), and known nationally. He also had a personal stamp of approval- a friend of mine’s girlfriend also had her surgery with this doctor earlier in the year. He thought the doctor was awesome, and Tim* is very picky. If he liked this doctor for his boo, I knew he was good. But even with T’s stamp of approval, I did my research, which I highly suggest. DO YOUR RESEARCH. Google. Ask anyone you might know personally in the medical field what they may know about the doctor. Ask people who have been  through this who they used. This person is going into your body with sharp instruments and basically has your life in his/her hands. Consult with more than one surgeon/OBGYN if you need to. Me, I want to know everything when I pick a doctor: What were other patients’ experiences? Where did they go to school?  Where did they do their residency? Have they written any papers? What certifications or specialties do they have? Do they like Chipoltle? I need to know.

 

At least the waiting room was nice....
At least the waiting room was nice….

Fortunately for me, I was sold on visit one. O and I went for the first in April. Dr M** was awesome:  he had Saturday hours, multiple locations, and his staff was friendly. The only downside was the wait. We did wait for a long time. However, I’ve just come to take this as part of the  deal of healthcare in America. Especially of you have a doctor who is good with a lot of patients. His staff  did the best they could….I guess

Here’s where he sold me: I had my records sent from my GYN….except, they never sent them. Womp. So I’m going in prepared to talk with this man in detail about whats on the ultrasound, and he didn’t even have them. BUT what he did, was based on my symptoms and the information I could give, he drew what my uterus looked like with the fibroids and could describe the symptoms I had but hadn’t said.  You sir, are magical. We agree, surgery to remedy this.

Another piece of advice: Bring questions. Write them down, use your phone or tablet note app, whatever, but bring all of your questions and ask them. Also, be prepared to take notes and write down the answers the doctor gives you.

O and I discussed surgery and my options over brunch at a diner. I called my mom and let her know what was going on, and asked if she wanted to come down. Of course she did. So that Monday, I called Dr. M’s office and set the surgery date: June 7, 2013

Next: Part Two: The Preparation

 

*His name is not Tim. I do not use any real names in this blog without permission

** Similarly, if you are interested in the Details for Dr M, please contact me.