 TAH w/spinal, for fibroids |
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TVH 4 days post-op, Spinal block
TVH - with spinal anesthesia
TAH/BSO - With Spinal Anesthetic and Sedation
TVH - awake with a spinal
Abdominal Hysterectomy TAH/BSO - "Camelot" after, spinal anesthesia and no sedation!
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--- Hi, My Name is Linda. ---
I am an active, strong, healthy 38-year-old woman, married, with no kids (by choice). In December 2000 I had a Total Abdominal Hysterectomy (TAH, kept the ovaries) under a spinal, for fibroids, after years of pain and problems. My recovery has been easy, with no real setbacks or complications. I just had my four week post-op check up today, and was cleared to return (slowly!) to anything I want to do, including swimming, working out, riding my horse. gardening, and even sex. Four weeks is pretty quick to get to this point. My doctor says I've healed more quickly than he expected. I still have some discomfort, and am weak from inactivity - probably up to 25% of normal for me - but I'm eagerly looking forward to getting back to living life as a regular person, not a "patient".
When I was first considering having a hysterectomy I wanted as much information as I could get my hands on. If you work the same way, keep reading…
I do want to caution you though - a hysterectomy is major surgery. Even if things go well, you will have pain, you will be tired, things that should be easy will be hard for a while. It's a bumpy detour on the road of life. Things went very well for me, and it's easy for me to say "Go for it! You'll feel great, and your problems will be over!" But there is always risk of new problems, and you have to be sure for yourself that it's worth it.
--- How I Came to Need a Hysterectomy ---
I got my first period around age 12-13. I had very bad cramps and occasionally heavy bleeding right from the start. I had to get doctor's notes to be excused from gym class, stayed home a day or two each month. Had to come up with lame reasons for not swimming in our pool (which I loved), with all my friends. Everyone seemed to think I was just having a hard time adjusting to growing up, and should get used to it. At 15 I had just the "D" part of a D&C - it was no help. The doctor said I probably had endometriosis and there was nothing that could be done about it. A hysterectomy of course, but they "couldn't" do it in someone so young. Took lots of Motrin, Darvon, and Darvocet. I went on the pill at 15 to see if it would help. For 20 years I had very good results with that. Not perfect, but tolerable, and very predictable.
At age 35 the problems came back, suddenly, and worse. Long, very heavy periods (menorrhagia), cramps (dysmenorrhea), clots, flooding, painful intercourse, bleeding after sex, aching back and legs, and fatigue. I'd get cramps so bad that when they hit me in my sleep I'd dig my nails into my husband's leg. Ouch! For 3 years the problem was treated with various different kinds of BCPs, with worsening results. My doctor kept insisting this was all "normal", and refused to consider checking me for any cause. I specifically asked about fibroids several times, since I had classic symptoms. I was told it was very unlikely, that she couldn't feel anything unusual, and in any case they'd just treat those with the pill anyway. (All of which was completely out of line with normal medical practice, I know now.) My period became unpredictable, so I couldn't even plan around it. For three years I couldn't go for long rides with my horse, couldn't plan camping trips, had to hope for the best on vacations, weaseled out of social events (pool parties!) at the last minute, etc.
The constant, heavy bleeding was the last straw. In September/October 2000 I bled for 30 days straight. Many days were bad enough (I know now) that I should have gone to an ER for help. I couldn't do anything with my horse, couldn't plan anything, and gave up volunteering at horse events. Finally I had to turn down clients because I couldn't sit through a meeting, or even drive as far as their offices. I couldn't even make it to the market. Committing to projects was out of the questions. I basically had to temporarily shut down my company and turn away all my customers.
--- Getting Help ---
I finally discovered the magic words that make doctors jump into action: "It's so bad that I can't work." Once I uttered this phrase I was immediately referred to a gynecologist. She did a cursory exam and suggested an endometrial ablation, then referred me on to another gyn who does ablations. He also did only a regular pelvic exam, and we set a date to do a thermal balloon ablation, along with a tubal ligation. It sounded promising, but didn't work out. Instead he found fibroids both on the inside and outside of my uterus. Fibroids inside preclude balloon ablations. So I ended up with the tubal, a D&C, and partial removal of one fibroid. I couldn't very well start my business up again, not knowing if I'd be able to work next month, or the month after… My next period was not a happy one, and I had no expectation of things improving over time, so when I saw my gyn again I asked for a hysterectomy. I gave him a long list of reasons why now was the right time to do it. I'm sure it helped that I've finally reached my late 30s, an age at which women apparently become able to make rational decisions about their bodies. To my limitless relief, he agreed.
--- Getting Ready ---
They say waiting is the hardest part. For me, waiting to get approved and scheduled was the worst. Once I knew it was actually going to happen there was no looking back. I'll leave out the details of my to-do list, but I will say that before your surgery you might want to plan as much fun as you can possibly squeeze in. You'll feel better and be more fit for your surgery, and feel less deprived during your recovery. In addition to the shopping, yardwork, cleaning, and other chores, I rode horses with friends, ate all the foods I wouldn't be able to indulge in for a while, joined a friend for hiking and went to lunch, had more friends over for dinner, and spent as much time as I possibly could outside, working in the yard and playing with my horse. I think it made a huge difference in my recovery.
My surgery was scheduled for December 19th. Because of that, and two other surgeries in my family (!), we had Christmas early - family, dinner, presents, the whole thing. That worked out much nicer for everyone, and we got to have fun and enjoy ourselves, instead of struggling through the holidays.
--- The Big Day ---
I was scheduled for surgery at 4:00. I had to do the GoLytely bowel prep the night before (yucky, but not horrible), then clear liquids only, then nothing after 6 a.m. I spent the day hauling manure to the veggie garden and rototilling it, so the soil would be ready for planting in the Spring. Bummer of a day to not be allowed to drink anything! The weather was dry, sunny, and in the 80s. By the time I went to the castle, I was ready to lie down and rest for a few weeks. My Dear Husband (DH) drove me there, and stayed until I was out for the night. A neighbor very kindly took care of feeding the critters that evening so we weren't worried about my DH having to rush home.
--- Having A Spinal Block (in detail, for anyone considering it) ---
I had my TAH done under a spinal block ("spinal"). I felt *so* much better coming out of surgery, and recovery was easier than the prior month's D&C/tubal (hysteroscopy and laparoscopy - kept overnight due to nausea). No brain fog, no nausea, no week-of-being-stoned... I'll never have a general again, if I can help it. (Come to think of it, I'd prefer to avoid surgery altogether, if possible.)
Here's how it went, as I remember it:
The anesthesiologist called me at home the night before. I thought he'd want to use a general, and I was prepared to try to talk him into an epidural, based on what I'd read here. Instead, he wanted to do a spinal. I was kinda confusing a spinal block with a spinal tap, which I've only seen done on TV, and it looks mighty painful. He told me I might feel a stick or pinch, but nothing awful. I asked him if it involved any Screaming In Terror, and he said he sure hoped not!
I'd heard of people getting awful backaches and headaches after a spinal, and he said they use a new kind of needle, which is very small, and has some special kind of tip, that has pretty much eliminated that problem. It also used to be that you had to lie flat for hours afterward. That's no longer the case. Afterward I did not have a headache or backache, and only had a tiny tender spot (if I pressed on it) where they did the injection.
He said he would use two drugs in the spinal - morphine, for pain control up to 18-24 hours after the surgery (it just hangs around - they only put it in once), and something to numb/paralyze me from the ribs down. There would also be two drugs in the IV - I'll probably spell them wrong, but I think he used Medazilan and Probofal. As I understand it, one makes you not care, and the other makes you not remember. I was worried that I might feel stuff - he assured me if I did that I could let him know, and he'd turn up the drugs in the IV. I asked if I'd be *capable* of letting him know (or too drugged), and he said I would be. Well, OK, let's do it.
When I got to the hospital, they took me to my room before surgery. There was my smiling roommate, who'd had a TAH the day before, using a spinal, with the same anesthesiologist - sitting up and talking to her friends. That's always nice to see. She told me not to worry, that nothing hurt, and I'd be fine. <whew> She was right.
I went into pre-op, got the IV installed, talked to the doctor and anesthesiologist, then got taken to the OR. No drugs yet. Going into the OR was a pretty casual experience really. They hauled me off, wide-awake, to the surgical area. Had to park me in the hall for maybe 10 minutes while they got my suite ready (they'd accidentally scheduled me for the cardiac surgical suite, and we wouldn't want that!). Finally they were ready, and wheeled me in. There were about 5 people, including my doctor and anesthesiologist. They were all laughing and joking around, and I thought it was nice that the people working on me were in a good mood and seemed to like each other.
I'm not sure when they started the "don't care" drug, but I remember being asked to roll on my side and curl up (so the spaces between the vertebrae are more accessible). I don't remember feeling the shot. Maybe a little needle stick, but I know it didn't hurt even as bad as a blood draw. They may have numbed the area first, I don't know. Then I rolled onto my back, and they checked the progress of the numbness, which starts at your toes, and works its way up.
Then I think he started the "don't remember" drug.
I've been told I was wide awake, and chatting with the doctor. He even offered to give me the scalpel and let me do it myself, since I was being such a pest with questions, and asking to see stuff. But I don't remember any of that. I think the "don't care" drug took care of any fear. I could have been scared or grossed out, I don't know, since I can't remember. I think I was pretty happy and calm though. The bottom line is that I can't tell you what it was like being awake, 'cause when they took me to the mother ship they wiped out my memories of it. I understand alien abduction stories a lot better now. If you're really brave, you could ask them to leave out the amnesia drug. It would be kind cool to know what happened. Then again...
If I got the story right, my roommate got put under further, 'cause she kept moving around, and we can't have that... I wouldn't worry about being awake, but if you are stressed about it you might ask the anesthesiologist if they can just put you a little further under.
The first clear memory starts up again as I was getting wheeled into recovery. The anesthesiologist brought me in and introduced me to the nurses. I was awake, not confused or spaced, a bit sleepy, and comfortable. They kept me there until I could wiggle my toes. Feeling and muscle control comes back from the top down, so the last thing you can do is wiggle your toes. They had monitors hooked up to me, and one would beep if my breathing got too slow (which it did every time I started to drift off) - so that got to be a game, remembering to breathe enough that it didn't beep at me. I could tense up my thighs, then bend my knees a little, then move my ankles, and finally wiggled my toes and they sent me off to my room. It was nice to be able to greet my DH and Mom in whole sentences.
The pain control in the spinal (morphine) was very effective, and I didn't need anything else until around noon the next day (my surgery was at 4pm). If it weren't for a little misadventure with pain meds (of my choosing) that wiped me out at that point, I'd never have felt drugged at all the whole time. I think it made a huge difference in how I felt, and how well my recovery went. I only had a tiny bit of itching from the morphine (my nose and cheeks, mostly) - if I hadn't known that it was a possible side effect I would've just thought it was the dry air. My roommate had more itching, but was OK as long as they brought her Benadryl on time (she had to remind them a few times).
I don't have any experience with epidurals, but I'd guess it's kind of a toss up between a spinal and an epidural. Take either one if you're given the option.
--- Healing ---
The really brief summary:
Tuesday - 4 p.m. surgery. Easy, alert, comfortable.
Wednesday - Fine in morning, IV disconnected. Very drugged in afternoon, catheter out at noon (they let me do it - not bad), first walk, lots of visitors, couldn't keep eyes open, clear liquids only. Woke on own every 2 hours to pee, walked for 15 minutes each time, back to sleep.
Thursday - Non-clear liquids for breakfast. Different drugs, not stoned, really bad pain. Showering was horrible - pain from water trickling over frazzled nerves. (Hint - do *not* cry. Crying hurts!) Solid food at lunch. Started on 1/2 Percoset/4 hrs - slightly stoned, discomfort, but much better. Slept all night except when woke for drugs.
Friday - Starting to get bored. They let me remove my IV thingy. Went home in afternoon.
Saturday - Doing laps walking around driveway loop, drinking, resting, resting, resting.
More details:
- I had a wonderful roommate! I had thought of getting a private room, but was very happy to have company. Same operation (except she also had a BSO), same anesthesia. She was one day ahead of me, and full of helpful info on what to expect. We helped each other out (well, she helped me more), went for walks together, chatted between naps... And the best thing - she got news the last day there that she was cancer-free! I hope she drops by to visit here.
- Ladies, they are right about walking. Walk, walk, walk. I walked about 15 minutes every 2 hours or so. At first I did laps around the center area, so if I got in trouble the nurses would find me. Later I ventured to all corners of the floor. I considered going to other floors, but couldn't bear the thought of a bumpy elevator ride.
I haven't been nearly as achy and stiff as I was after my laparoscopy/hysteroscopy. I'm more coordinated, less stumbly, and can take bigger, more even steps. I think this is because I've been walking so much.
- I did use almost everything I brought. Get yourself some upbeat, fun jammies. I felt almost human cruising the halls in my atomic-age/Jetsons pjs. I left my heating pad at home, and they had to set me up with one. Played Yahtzee a lot! I wish I'd brought my cheap little binoculars. We had a huge wall-to-wall window with a great view. It might have been fun to watch people and birds with binoculars. They even let me use the purple VetRap I brought to hold the IV in place! Very comfy, and everybody asked about it. ($1.99 at your local tack store - lots of colors.)
- Keep that tummy pillow with you! Even if you feel pretty good walking without it, you never know when a cough my sneak up on you. I discovered the very best thing for a tummy pillow - my buckwheat-hull-filled travel pillow. It's kinda U-shaped, and like a light beanbag, so it forms to fit you. Also handy for sitting on (when your tailbone gets sore), and sleeping (when your ears begin to resent being squooshed).
- Peeing and passing gas aren't things that "just happen", at least not for me. At first peeing was really hard. Not painful - it just didn't happen. Maybe 6-8 hours after they took my catheter out I figured I'd better get things going or they'd put it back in. I'd been drinking *lots* of water, too. They gave me a squirt bottle to fill with warm water. Hint - visualize babbling brooks, raging rivers, waterfalls, rain... rub your back and belly, use your squirt bottle. Don't sit there and read or think about other things - you actually have to work at it. I'd spend maybe 15-20 minutes in the bathroom each time. At four days post-op I was finally able to sit down and pee like a normal person. Passing gas was the same at first - go hide out, rub your back, find pressure points on your back that seem to help, rub your belly... Just waiting for it to happen on its own is a good way to end up in nasty pain. By the way, that really sharp, burning, stabbing pain like you've never felt before... that's gas pain. The good news is you can control it if you put your mind to it.
- Ask for what you want in the hospital. All my nurses were wonderful. They'd do anything for you, but you had to ask. I asked for Gatorade (not on the menu), and got 4 cans, plus ice, each time. You can ask them to wake you for your pain meds through the night, or to wait until you ask for them. I did have one nurse decide to "let me sleep until breakfast" instead of waking me at 6:00. Owww. You might bring a travel alarm clock, just in case, so you can stay on schedule better. I was trying to get away with the bare minimums on meds, so being 2 hours late with them got kinda ouchy. Don't just wait for them. I'd go out to the nurses' station and ask for mine.
- When you walk at first, if you get dizzy or queasy, put cold wet towels around your neck and wipe your face with them. The first time I tried to get up (on Demerol and Phenergan - big mistake) I was drenched in sweat right through my gown just from sitting up with my feet over the side of the bed. The cold washcloths really helped - be sure to ask for them. My nurse also kept reminding me to keep my eyes forward and look ahead down the hall, not down, and that make a surprisingly big difference in how I felt.
Once I was home from the hospital I just took it pretty easy. Spent almost no time in bed. Watched TV lying on the couch, hung out on the Hyster Sisters' boards, talked on the phone, walked around. I only got Darvocet for pain, but didn't need anything after 2 days at home. During my recovery we had 2 parties - I did not help, but got to hang out (in pajamas!) and eat the food! I fought off a cold (salt water gargles, vitamins, rest), had out of town visitors, and Grandma-in-law stayed with us for a week (great company). Went to dinner at 2 weeks (easy), fed critters a few times. Walked a mile at 3 weeks (hard coming back uphill). Also took over almost all horse feeding and care (I don't have to deal with stalls/turnout though!). Started doing short periods of computer work from home. At 4 weeks I walked 1/2 mile, then spent a couple of hours pulling weeds, no problem. Driving (automatic, full-size truck) to appointment today was no problem, but hopping down from the cab when I got there reminded me I still need to take things easy!
--- A Few Quick Hints ---
Don't plan on using your recovery time to get caught up on paperwork or other projects. You need this time to rest, take care of yourself, and recuperate. It's amazing how drinking tea, remembering how to pea, lying down resting, and taking short walks can fill up your day.
Get loose-fitting clothes that you will feel comfortable going out in. If you don't have anything to wear, you will find that going for walks around the neighborhood just won't happen.
Get some cheerful, comfy pajamas that make you happy - several sets. You'll be spending a lot of time in them. Wearing frumpy old sweats and stained t-shirts will make you feel down.
If you are a gardener, do all your heavy work (preparing beds, amending soil, tilling, ... ) before your surgery, so you'll be all set to do the light stuff (planting seeds, propagating new plants, pinching back tomatoes,.. ) as you regain strength afterward.
If you have horses, get help. You will not be up to handling them for several weeks. My husband has been wonderful about taking care of our critters. At two weeks I could carry a flake of hay. At three weeks I almost passed out from trying to pick out my horse's feet. At four weeks I'm ready, with the help of a friend, to try leading my very quiet mare. This is a good time to try clicker training, do lots of grooming, and work on groundwork.
For any rural folk, schedule for Fall or Winter if you can! You'll feel much better about huddling on the couch all day if it's cold and miserable outside. You can let the yard go then. The grass can go without mowing. Rain lets you skip watering for a while. Flies won't be such a problem in the horse pen. When things start to pick up in Spring, you'll be ready too.
--- What's Next? ---
Work with my animals! The horseshoer and equine chiropractor will be here in the morning to be sure my mare is OK to start light work. Get my business going again. Get my yard cleaned up, and veggies planted. Put away my recovery stuff and write thank you notes. Continue to eat right, exercise, and get enough rest, even after I feel better. I've joined a gym, and am looking forward to getting fit and strong. Enjoy camping, travel, and daily life with my husband, who has been a rock of support through this whole adventure. Help new Hyster Sisters, and keeping in touch in the wonderful online community Kathy has created for all of us.
[Edited by HorseWoman on 01-17-2001]
Related Titles
TVH 4 days post-op, Spinal block
TVH - with spinal anesthesia
TAH/BSO - With Spinal Anesthetic and Sedation
TVH - awake with a spinal
Abdominal Hysterectomy TAH/BSO - "Camelot" after, spinal anesthesia and no sedation!
Chuong Pham, M.D.
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Susan D. Hunter, M.D.
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David Mainman, M.D.
Desert Bloom Obstetrics & Gynecology
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