LAVH: Surgery in 2 days, a lot of questions (Baby mentioned)

Hi Ladies,

I'm a bit slow on the uptake, and haven't really done my research about my LAVH

Long story short...

Had Mirena IUD taken out about 4 years ago to try to have a baby. Had a couple days of spotting for a period when I had the IUD. After it was out, the floods began, with major clots, I go through the largest size Depends pad in less than an hour, and they last about 8-9 days. A year later after the IUD was taken out, dx'd with secondary infertility.

Dealt with the periods simply because I'm tired of going to the doc and hearing that my weight is my problem. (Yes, I'm overweight, but this isn't NEW, I was born overweight (literally) and I haven't had the problems my whole life, so I don't think blaming my weight should be the standard answer)

Surprise last April, I'm pregnant! (3 years after being told I can't have any more kidlets!) Had a "missed" miscarriage at 13 weeks. Hubby was deployed, ended up having to take pills (opted not to have D&C) to bring on the actual miscarriage at the end of May. (Sorry, not sure how to say that)

Had a horrid period in July, hubby got home just after it ended. We had been talking it over, and decided that while the baby would have been a blessing, we were at a different place in our lives than when I had the IUD out, and I felt so terrible after the miscarriage, that we didn't want to try anymore, and I would talk to the doc at my follow-up about BC. Had my follow-up visit with my OB on August 17 for the miscarriage, talked to her about hysterectomy for the periods, she agreed, but said I needed a endo biopsy and a US of my ovaries. Wanted to do bloodwork to check my HCG level because I was still testing positive on pregnancy tests...surprise, surprise, pregnant AGAIN!

So...she absolutely wouldn't do hyst at birth, said was better to wait til things went back to normal. Baby will be 8 weeks the day of my surgery, and we're moving cross-country 6 weeks and 2 days after my surgery. It will entail a month of travel.

My questions:

Scheduled for LAVH, I realize it could turn into TAH. Planning to keep ovaries, lose uterus/cervix.

1. I'm nursing my little guy, and have zero intentions of weaning in the next 2 or 3 years. Anesthesiologist assures me I don't *need* to pump and dump, said some mothers prefer to, but my guy doesn't like bottles, so we're just going to brave it. Hubby will be at the hospital with him during my surgery, and the recovery room nurses will help us feed him once I'm out of surgery. Doc says to expect about 2 hours that he will not be able to nurse, does this sound about right to you ladies? When I was doing the pre-op stuff, the surgical center staff asked who my doc was and said I'd be away from baby for about 4 hours, but he didn't know they were going to allow my son into the recovery room, likely before I'm even completely awake, so I don't know was he adding in recovery room time?

(Sorry for the dumb questions...I should have asked my doc, but I think I had my head in the sand about this for the past 10 months, because I did absolutely zero research beyond talking to my mom about her hyst until 2 days ago!)

2. Doc said I have to stay in the hospital overnight, is that the norm for a LAVH? (I HATE hospitals, so I'm seriously considering AMA if things go well, is that a bad idea? They ARE allowing my munchkin to stay in the hospital with me as long as hubby stays, too, so at least I don't have to freak out about him starving )

3. Bowel prep Doc sent me home with Colyte. I've read all the horror stories, sigh. Guessing I will spend Tuesday in the bathroom. I was told to eat a normal breakfast and a light lunch and dinner, but the directions say nothing solid after I take it? Was told to start it around 3pm, but from what I'm reading here, I should probably start it earlier in the day. Pharmacist said use the flavor packet OR Crystal Light, does anyone know what is considered a clear liquid? I like the tangerine/strawberry Crystal Light, is that clear or do I need to stick with the lemonade? What time would you all recommend starting it, so I'm done with the bathroom trips by say midnight?

3. Has anyone done a bowel prep while nursing? I've read it could affect the quality of my milk, is that going to hurt my little guy for a couple of days? (I have some pumped, but like I said, he's very resistant to bottles, and it's iffy whether he will accept one at any given moment, and we've been working on this issue for about 5 weeks now, so I don't expect it's going to miraculously improve in the next 2 days)

4. How bad should I expect my abdomen to hurt after LAVH? I've read to use a pillow while nursing so he can't kick my stomach, any other suggestions? Should I expect pain in that area due to the nursing? (Like the afterpains I had when he was born for a week or so?)

5. I'm not sure how I missed it, but I didn't expect my vagina to be "torn up" after the surgery (I know about the cuff, I just didn't expect it would look any different from the outside)...should I expect it to hurt/sting when I urinate? If so, is it safe to use water or witch hazel in a peri bottle to help alleviate it, like after childbirth? What about bowel movements? Should I use colace for a few days?

6. Sex afterward....with the cuff, if I don't have problems with DH hitting my cervix now, should I expect pain after from him running into the cuff? Does the cuff stretch to accommodate? (Hope that makes sense)(I know we have to wait 6 weeks, that isn't an issue, I'm just nervous about it already because due to pregnancy problems, it's been about 6-7 months already, so we're looking at about a 9 month time by then.)

7. Pain-wise, what should I expect after the surgery? What will hurt? When will it hurt? (Like, should I expect pain while sitting in a chair or in the car, pain when moving to a standing position, when sitting up in bed, when lifting my baby, etc. Will my vagina hurt when sitting, or is it mostly abdominal pain?) Doc is giving me percocet after, how long did you ladies need pain meds after surgery?

8. Have any of you had LAVH done with a spinal rather than general anesthesia? Doc plans general, I'm wondering if I should call Tuesday and ask if I could possibly have it done with a spinal instead for the baby's sake?

9. As I mentioned, I'm moving 6 weeks after my surgery and will be traveling cross-country for about a month. What can I expect to feel like 6 weeks out? Hubby can do most of the driving, due to baby we plan on 300 miles a day, so between 6 and 8 hours of travel a day. I can probably sleep most of it, so tiredness isn't a concern, but should I anticipate any problems sitting by then? Will most/all of the pain be gone by then?

I'm sure I am missing some important questions, and I apologize for the length of this post. My internet works very sporadically, so researching this at the last minute is difficult

I don't have answers for you, but wanted to say that reading your story its just amazing and wonderful that you have half of these concerns about your son considering everything you have gone through to have him. You are definitely a strong woman and there are some great women on this site that are going to respond, I will be waiting to read. Good luck with your surgery, I will be doing my bowel prep tomorrow and pre-op appmt. My doc said all clear liquids, nothing orange or red. One night in the hospital and 6 weeks recovery. With all your questions, I would be calling the doctor/surgeon discussing your concerns so you know that yall are on the same page with treatment that's right for you. Of course I was armed with info from this site.

re breastfeeding: I nursed all 5 of my kids - some of them as long as 2 years, so I'm a big advocate. That said, you are planning on a lot. A lot of activity. A lot of nursing. Not getting any meds that will affect baby. I encourage you to get a pump TODAY (you can rent them from hospitals etc). You might only get a couple ounces, but at least it's something. Then your hubby can start the work to get baby to take a backup/relief bottle (best to do when baby can't see/smell/hear you). It may take patience. Think of it like a good insurance plan. (And it can be handy later on, too)

Also, suggest you call surgeon again, ask for list of possible meds, then call pediatrician for 2nd opinion.

Now might be a good time to talk with hubby about Who is going to be doing all of the packing! LOL

good luck

	Quote:
Originally Posted by dancingt re breastfeeding: I nursed all 5 of my kids - some of them as long as 2 years, so I'm a big advocate. That said, you are planning on a lot. A lot of activity. A lot of nursing. Not getting any meds that will affect baby. I encourage you to get a pump TODAY (you can rent them from hospitals etc). You might only get a couple ounces, but at least it's something. Then your hubby can start the work to get baby to take a backup/relief bottle (best to do when baby can't see/smell/hear you). It may take patience. Think of it like a good insurance plan. (And it can be handy later on, too) Also, suggest you call surgeon again, ask for list of possible meds, then call pediatrician for 2nd opinion. Now might be a good time to talk with hubby about Who is going to be doing all of the packing! LOL good luck

Gah, you're worrying me LOL. This little guy is my 5th also.

We've been working on him taking a bottle for about 5 weeks, he just won't take one reliably. (He seems to have a really bad gag reflex, possibly reflux? We've got lots of spitting up I don't recall with my others, we'll be talking with his doc about it at his two month checkup on the 7th, but I can't get him in for a check before my surgery, unfortunately) At any rate, we've tried about 10 different kinds of nipples/bottles, last week I got the Medela nipples, and we've had the best success with those.

I do have 23.5 ounces of milk in the freezer I've pumped, and when he will take the bottle, he isn't picky if there is formula in it, so worst case, we have some of that on hand, too, but the big issue is getting him to actually drink from the bottle. (We've also tried cups, syringes, and finger tubes) We've been really pushing on this because of the move, there will be times we can't safely stop, so we really need him to take a bottle, just in case. (Driving the Alaska Highway through Canada, pulling a travel trailer, sometimes there just isn't a safe spot to pull over)

My surgeon is my OBGYN who delivered him, and we've gone over the list of meds in detail that I might have. The only "dispute" was over whether I would need to pump and dump due to the anesthesia, but the anesthesiologist said it's personal preference? (Which makes sense, I've never heard of anyone who had a c-section under general having to do that???)

The only thing I *have* to do after surgery is take care of the baby, and mainly that just means feeding him. Hubby will be home for 4 days after surgery, so he can handle all but the nursing. After that, I'll likely have to do diaper duty, too, because my 16 yr old's favorite phrase is "Sharing is caring, Mom!" when it comes to the baby (she thinks I had him just to give her a living baby doll!), but she doesn't do diapers happily. (She will wash them, but she hates changing them)

Hubby will be gone for a week 12 days after my surgery, but my kids are all old enough to fend for themselves (my youngest next to the baby is 11), and they are all helpful to me, so even then mostly all I'll need to really do is nurse and diapers. The kids can cook and do laundry and whatnot.

Baby is 12lbs, doc said my lifting restrictions are not to lift anything except him. Even that, there's always a kiddo or hubby around if I need them to give him to me.

Do you think that's sufficient? (Seriously, because if nursing my little guy is going to be an issue, I'll cancel the surgery) Doc said percocet should be sufficient for pain relief after surgery, and I'm comfortable with taking that and nursing. Am I missing something? I'm not thrilled with Colyte and nursing, but I read on Mothering.com that it doesn't affect him?

As for the move, we have movers coming in to do the packing, so that isn't a concern, and my hubby is a saint, if I'm bedridden from now until the move, it won't be an issue. All I HAVE to do between now and then is feed the baby, diapers, and be able to ride in a vehicle, he'll handle everything else necessary, for as long as necessary. (And if I absolutely can't change diapers, 16 yr old will do her best and bribe the 12 yr old to do the ones she can't handle LOL)

I can't answer your questions re: breastfeeding but I did have LAVH. I had the surgery at 7:30 am and was home at 1:30pm. Pain was manageable and I really didn't use the pain meds. It did feel like I had just given birth. They usually insert a catheter which can cause burning when urinating for a short while. You might want cranberry juice which is suppose to help that. I didn't have bowel prep for the surgery but usually clear liquids would include jello, chicken broth etc. I have no doubt you will do fine.

You've given it a lot of thought. I'll try to answer a few non nursing questions. With bowel prep the key is to stay hydrated. Some Drs don't allow red liquids, some do, so clear liqs are clear juices, white grape and apple are good, gatorade drinks, Crystal lite, broth, jello. Drink lots and often because you'll lose a lot of fluids. For vag hyst, no, I had no vag external pain or issues just abdominal. It was mainly cramping and pulling sensations from my TVH, for my lap BSO I had pain at my incisions and related areas. But I used only Aleve at home. I was back to heavy work at 5 wks but felt good after 2 wks. As to length of surgery, it varies a lot, can be 2-4 hrs before recovery. Sounds like you are working on the bottle side of things and I hope you can get that to work out. Often they aim for same day discharge so overnight stay is not necessarily required. But you need to do OK with oral pain meds only, be able to walk around, empty your bladder adequately without a catheter, and eat/drink without nausea/vomiting. If you can do those, usually you can go home. I doubt you'd need to go AMA, they usually work at getting you out and if you know the goals you can just go straight to oral meds, etc. With a spinal you'd have to check on length of stay and how long until you could be up and walk. Last, sex. Yes things still work and expand and don't usually seem short. It can be different at first so be prepared to give it time at first. Hope I've answered a few questions. Good luck with all of this, I hope it all goes smoothly.

I know your surgery is scheduled for just a couple of days from now, but it sounds like you are taking on alot right now. This is major surgery, and you're dealing with so much already, what with caring for an infant and moving. I would personally not have the surgery while your child is so young unless it's an emergency.

In the event that you suffer complications, you may have even more difficulties. All the positive attitude in the world doesn't help ward off an infection, a hematoma (which is what I ended up with ) or other painful complications, which could set your recovery back even further.

Do you have some help lined up for the first few weeks after the operation? You won't be able to lift your son or really care for him for at least a few weeks after your operation. (I didn't feel "well enough" do much of anything until I was about 4 weeks post-op.) It's easy enough to say, "I know they say I won't be able to lift, but I'll just do it anyway -- he's small. It'll be OK." Unfortunately, all of the positive thinking in the world can't prevent an infection, or a hematoma (like I had) or popping stitches from lifting too much, too soon.

It sounds like you're not the type of person who rests alot and you will have lifting and other activity restrictions for a while. Even if you're feeling OK, you still need to restrict your lifting for several weeks to give your body a chance to heal right the first time.

Now, as to a couple of your other questions: The vaginal cuff is just where the vagina is sewn shut during the surgery. It doesn't really stretch. Most women find that sex after surgery doesn't really feel different. I couldn't tell I had a cervix before, and I can't tell it's missing now.

The length of your hospital stay will depend on how well you do after surgery. Many ladies have a 23-hour stay so that they are in the hospital overnight but are still technically "day surgery". You can check to see if that's how you will be handled. When I had surgery for my complication, I was home and "in my couch" less than 24 hours after they started the surgery, and I can really relate to you wanting to get home as soon as possible.

Bowel preps are different for everyone. When I took mine, it was all over in just a couple of hours.... but it took a long time to start working. I was prepared for it to start working in an hour, and I was waiting around doing alot of nothing for almost six hours before anything happened. You can try to time it, but your body will be the ultimate timer in this situation.

to you. I hope your surgery is successful and your recovery is smooth.

I feel like it will be easier to have the surgery while the baby is this young? Reason being, that he really doesn't require all that much energy right now. If I wait, he'll be walking, school will be back in session, hubby won't have any time off work, etc, so I wouldn't have the help available that I do right now.

Doc says I can lift him after, he's 12 pounds....is that out of line with others' lifting restrictions? (I can have someone else lift him for me if needed, so just curious what other docs recommend)

I'm actually a pretty sedentary person, and I spent the last 3 months of my pregnancy on bedrest, so I'm used to not being able to do anything/much.

My surgery is the 2nd, hubby will be gone for a week about 2 weeks later, but I do have my 16, 12, and 11 yr olds who are able to help with anything I need, except driving, but hubby will make sure we have everything we need before he leaves for training. Otherwise, he works 5 minutes from home, so if there was an emergency and I needed him, he could be home quickly.

Worst part of bedrest for me was not having a laptop, but doc allowed me to move between my bed and chair (my puter is about 3' from my bed LOL) due to restless legs, so it worked out OK...so if I'm able to sit after the LAVH, I *think* I should be fine?

(Honestly, there is nothing I have to do around the house, hubby pretty much takes care of everything already, about all I do on a regular basis is wash and fold diapers and take care of the baby. The thing I will have to "give up" is carrying the baby in his carseat and putting the carseat in the car, but the other kids can do that for me once I'm comfortable driving again.)

I fortunately don't have insurance concerns about my hospital stay, just hate being in them and between giving birth and my son being admitted for possible sepsis @ 3 weeks old, I've seen enough of the hospital to last me a while LOL.

Hubby is going to get me up early to go in for my pre-admit paperwork and to do my last bloodwork, so I'm planning to start bowel prep around noon (gag!!!)

Thanks for the advice ladies! I'm soooo tempted to cancel surgery for my baby's sake, but I know this is the best time to do it for me. Too much coming up in the next year, plus I know it can be hard to get approval for it, and right now, I have a supportive doctor. Who knows if my new one will be.

My lifting restriction was nothing over 20 pounds for 6 weeks... but that being said, my doctor said I really shouldn't lift more than a gallon of milk (about 5 pounds) unless I absolutely needed to do it. However, your general health may dictate otherwise. Just make sure you're not lifting him *and* the diaper bag *and* your purse at the same time!


Ah, I didn't see that you had older daughters to help out. Sounds like you have a plan.

Best wishes for a speedy recovery.

Thanks mjd!

I'm pretty nervous tonight. Colyte is horrid imo, I told my doc today it was her revenge for me being a pain in her rear for the past year

I stopped by her clinic (military hospital, our doc offices, lab, pharmacy, etc are all in it) when I went in for my bloodwork and asked about the possibility of a spinal instead of general, but no-go on that

Just in case I was forgetting why I'm having this done, my period started AGAIN last night. I already had a post-partum period that started May 12th, and I'm nursing the baby....I should NOT be having a period already at 8 weeks post, much less 2 of them in less than a month!

At any rate, having it done now, in addition to my other reasons, will hopefully mean I will have energy and not be in the bathroom every 30 minutes by the time my little guy is getting really mobile, so being able to keep up with him will definitely make it all worth it!