Saturday, July 20, 2013

Nissen Fundoplication, one week post-op

I've been having trouble with acid reflux or GERD for a couple of years now.  I have tried every medicine on the market to help it and nothing works.  I have followed all the suggestions for combating acid reflux.  It has gotten so bad that I have to sleep sitting up in the recliner.  If I don't sleep sitting up, I have aspirated several times on the stomach acid, which I can assure you is extremely painful and scary.

Several months back, my doctor sent me to a gastroenterologist who recommended a nissen fundoplication  surgery, following an EGD.  The EGD showed some gastritis and a small hiatal hernia, but the big news came from the Bravo monitor that they installed in my esophagus.  It relayed info to a pager-like device I had to keep near me.  Then after a few days, it detaches and passes through your system.  It was a really weird feeling, but it recorded 233 reflux incidents in less than two days.  And I thought it was a relatively minor sampling.  The nurses said that my GI is never impressed and this impressed him.  So, he referred me to a surgeon that specializes in this procedure.

That surgeon told me that I was too overweight for the surgery and that if he did it, the surgery would come undone because of the pressure in my abdomen.  He recommended a gastric bypass.  I definitely did not want that.  For one, I don't think it's natural and couldn't imagine the major lifestyle change that would entail. For two, my weight problem has nothing to do with overeating--it's about what kind of food I eat and the amount of exercise I get.  And three, I haven't heard many good things about that kind of surgery.  Even if I had wanted that, my insurance doesn't pay for it.  So, I went after a second opinion from the surgeon who took out my gall bladder two years ago.

I had to have one further test to be sure I was a good candidate for surgery, an esophageal manometry, which I blogged about prior.  That came out okay, so my surgery date was scheduled.

I went into the hospital last Wednesday for some preliminary bloodwork and got preregistration all taken care of.  Then Thursday, I checked in to the hospital at 10:30 am, with my procedure due to begin at 12:30. I have no idea why I needed to be there that early because it took forever for them to call me back.  I think it was at least noon before they came to get me.  Then it was over an hour waiting back in pre-op.  They had me go to the bathroom, got me into a gown, asked me lots of redundant questions, got me hooked up to an IV, brought Scott back, and left me to wait.  When I was changing, they gave me some mesh underwear since I was on my "cycle".  It was apparently made for someone a lot smaller than me.  They were nearly impossible to pull up, so I pulled on the legs and heard a "RRRRIP!" and then I was wearing a mesh miniskirt.  Oops.  Pair number two was treated a little more gingerly.  When I complained about them cutting off the circulation to my legs, Scott found some scissors and did a little creative cutting, making them "hicuts".  Scott found a surgical marker in the drawer and we joked about writing on my arms and legs, "keep this" and "don't cut here" or writing on my thighs and butt, "suck out as much as you like!"  Finally about 1:15 or so, they came to take me back and shot me with some meds in the IV that made my hand hurt so much I thought it would fall off.  They already had a bag of antibiotics up, ready to prevent any infections--I thought that was strange.  The only things I remember after that was seeing the robotic arms that they were using to perform the surgery and scooting from the bed I was on to a table.  I really wanted to see this robot.  My daughter Arrena was really freaked out by the idea of a robot-assisted operation.  If my mind wasn't too clouded by meds to be objective, it reminded me somewhat of Doc Ock from Spiderman.

I woke up in recovery.  I usually hate recovery because they are so pushy and I just want to go back to sleep and be left alone.  They weren't too pushy, though.  I barely opened my eyes, so most of my memory of recovery was what I heard.  The first thing I remember was saying that I needed to urinate.  They told me that I had had a catheter and so I didn't need to go, but that taking it out probably made me think I did.  I was as alarmed as I could be in that state because no one had said anything about a catheter.  I am betting that they hadn't intended to since it was initially supposed to be a two hour procedure and ended up being around four hours.  I was a little anxious about this since I was on my "monthly cycle".  My throat was sore from the  breathing tube, which is normal, but I had high hopes after the awesome anesthesiologist I had for my gall bladder surgery.  I heard them talking about which room they were taking me to and it seemed it changed about three times before they decided on one.  I also heard them talking about trying to find my husband and the family of another patient and saying that they hadn't found either.  They told me I would be able to call my husband's cell phone when I got up to my room.

When I got to my room, the orderly remarked that there wasn't a phone in my room.  I also noticed that it was 6:15, five hours after they had taken me back to surgery.  When the nurse came in, I asked her to call my husband.  She did and the call connected, but the reception was bad so they couldn't hear each other.  I was really anxious about finding him.  The next thing I needed was ice for my throat, which they obliged me with.  When she came in again, I said that he'd had a pager.  She said they couldn't page him from there, but she would try to find someone downstairs to page him.  Apparently he was having a hard time downstairs.  He had asked about me about three hours into the surgery and they told him they still had two and a half hours to go.  Then he couldn't find anyone to tell him anything.  They had given us a paper telling the family what to expect.  It had a number on it to call, so he tried calling that, but just got voicemail.  He found another number to call and finally found out where I was and got to my room about 7:30pm.  Poor guy!  Over six hours, not knowing what was going on!  As soon as the nurse came in, he requested that they locate the house supervisor.  She came up pretty quickly and Scott told her the whole story.  She took down notes and apologized and promised to look into the problem and have someone come talk to us in the morning.

7:00 is shift change there, so I got a new nurse right away.  He was my favorite nurse the whole time I was in there.  I asked him where he was from because he had an interesting accent and he said, "Kenya.  Guess I should have said Lenexa, though."  He asked me about a billion questions, again all redundant.  He threw in a nonsense question, just to make sure I was still listening since I had been saying, "yes" for so long.  When the female tech came in, I asked her to help me into the bathroom because I desperately wanted some underwear on.  Getting out of bed was an ordeal since I was hooked up to an IV and also was wearing floaties (inflatables) on my legs to prevent blood clots.  I had to go to the bathroom every two hours between the IV fluid and the ice and water I was drinking, so every two hours, I had to call the nurse in to unhook me and help me out of bed and to the bathroom and then hook me back up afterwards.  Relieving myself was an ordeal in itself.  I felt the urge, but once I got in there, I had to squeeze and squeeze to get it to come out.  It sometimes took ten minutes to get it all out.  The nurse said that was normal, though I don't remember having this happen with any of my other surgeries.

They gave me fentanyl for painkiller in my IV and I was loving that stuff.  Made me totally loopy and floaty and immediately sleepy.  The problem was how fast it wore off.  The morning nurse started giving me two lortab 5s to make sure I could get by on that since that was what I would be going home with.  After that, I only asked for IV meds once more.  The nurse also gave me a shot of something in the stomach to prevent blood clots.  I was a little nervous about that, but it didn't hurt.  They brought me a breakfast of French toast.  I was surprised because I was under the impression that I would be on a liquid diet for a while, so I didn't eat it.  When the room service guy came back, I asked him about it and he said he had me down as on a soft diet.

My surgeon came in late morning and asked about my eating and said that he'd like me to stay another day until I was able to eat something solid.  He said that the reason that surgery went so long was because my anatomy had made it difficult--for example, they had to keep lifting my liver out of the way.  He said for that reason, I would probably be quite sore for a while.

My husband needed a break, so the moms brought the kids up to visit after they ate lunch and my mom stayed with me while my husband went home with everyone else to take a nap.  I nibbled on soup and an egg salad sandwich, just to make them happy, but I didn't feel like eating much.  Plus, I thought it was dumb that they were giving me gas-causing foods and feeding me with a straw that introduces air into your system.  I decided to eat the bare minimum to get out of there and then create my own diet based on my research and how I felt when I got home.  Dinner was some sort of tasteless fish, fried potatoes with skin-on (hello?  hard to digest!), and some green beans that were so hard to chew that my mom couldn't eat them with her dentures--yes, I passed off most of my food to her so it a) would not go to waste and b) would look like I has eaten more than I had.  Since I was taking in fluids and able to go to the bathroom okay, they unhooked my IV.  I slept off and on the rest of the day.  I finally turned on the TV for the first time.  Up to that point, I just wanted to sleep and eat ice and go to the bathroom.  The nurse also helped me get into the shower.  My husband came up later for a few hours, but went home to sleep since I was doing well.

The nurse the next morning came in to give me my belly shot and literally stabbed it into me!  OW!  I was expecting a tiny poke like the one the day before, but she was so violent with it, my stomach muscles involuntarily contracted, making it worse.  I still have a bruise on my belly from it.  I nibbled some scrambled eggs for breakfast, but still didn't feel like eating--it was painful and made me feel bloated and uncomfortable while I was digesting.  The on-call doctor came in and told  me that I could go home, so we waited for the nurse to get everything together so I could leave.  They delivered a lunch of pot roast, mashed potatoes and gravy, mushrooms, etc.  I nibbled a little bit of it, but before I had too much time with it, the nurse came in and said I could go when I wanted to.  So, I got dressed, Scott gathered up my stuff and the nurse wheeled me out.

I went home and went to sleep.  I had been trying to sleep all morning but every time I would doze off, someone new would come in the room: shift change--new nurse, nurse's tech, doctor, room service guy, someone from the respiratory department, etc.  I went back to mostly liquids.  I had some chicken noodle soup that evening.  The next day, I ate mostly liquids and mashed potatoes and crackers.  Since it was Sunday, my husband tried to talk me into going to church with the rest of the family, but I did not feel like getting out the day after I got home from the hospital.  I didn't even feel like getting dressed, though I did shower.  I was finally able to start going to the bathroom without having to work at it as much as I had been.  Around bedtime, I stated having chills and body aches.  My husband said I was slightly warm (kids have lost all thermometers in the house).  My mother-in-law asked me if I was doing my breathing exercises and I hadn't been.  So, I started doing them again and I felt much better in the morning.

Monday was pretty much the same.  Tuesday, my mother-in-law thought maybe I could handle a cheeseburger since ground beef is pretty much already chewed anyway.  I decided to split a happy meal with Billy since he wanted a PB&J.  He would take the drink, apples, and toy and I would take the baby-sized fries and the cheeseburger.  However, they messed up the order and gave us chicken nuggets.  The coating was a little rough, so I decided not to try it.  While my baby boy likes to strip the coating off his nuggets before he eats them (OCD, I think), I do not care for naked chicken.  So, I slowly and carefully chewed the tiny order of fries and did okay with that.  For dinner, the moms and the kids were having Applebee's, so I ordered a cheeseburger and ate about half of it, chewing thoroughly.  It kind of takes the joy out of eating because I have to chew things so much that I chew the flavor right out of it.  This is really going to reteach me about eating.  By the time this is over, I will be reprogrammed to eat to survive instead of enjoying food.  Maybe a good thing, but not really what I had bargained for.  I tried to spend more time sitting in the living room with the family instead of in my bedroom recliner either napping or watching TV, per my husband's request.  He thought the more I was up, the faster I would heal.  When I went to bed, I decided to try sleeping in the bed, instead of the recliner where I had been sleeping for I don't know how long.  And I tried sleeping on my stomach.  While it was difficult to get comfortable and I woke up fully to change positions since I am hyper aware of my stomach soreness and I was a little more sore when I woke up, it was nice to be able to sleep in my bed and to sleep in my favorite position.  Since I left the hospital, I have been having trouble sleeping.  I guess it is probably due to sleeping too much the first few days and being uncomfortable.  I stopped taking my narcotics during the day on the second day home and only take them at night (only use Aleve during the day).  I used to be knocked out with a Lortab 7.5, but taking two 5s isn't making me the slightest bit sleepy.  Tuesday night I had a horrible time sleeping even though I took a sleeping aid.

Wednesday, the moms were going home, so they wanted to have a final lunch together before they left.  My hubby chose Chinese and we tried to figure out something that I could eat, since I am pretty picky about Chinese food.  I love crab rangoon and they thought I should be able to tackle that fairly easily.  I think I was too caught up in the social aspect of lunch (so hard to concentrate on eating when meals are social by nature in our culture) and wasn't paying attention to chewing carefully.  I got about 2/3 of the way through one crab rangoon and realized that it was stuck.  And it hurt.  A lot.  I sat back suddenly and tried to lean back to give more room for digestion (my mother-in-law suggested that I go "recline" for a while in my room following meals so I could digest because after solid foods, I was a bit uncomfortable for a little while).  The kids were alarmed and I excused myself to go to my bedroom recliner.   I sat there for just a bit when I suddenly retched.  I had grabbed a handful of tissues and spit into them, then called for help.  My mother-in-law came to my rescue and got a trashcan for me as I began to clean myself up.  The crab rangoon had dislodged and come up.  They called it "regurgitation" as opposed to "vomiting" although it felt much the same except it hurt more and was somewhat scarier.  At least there was no stomach acid with it, so it didn't taste horrific coming up.  That scared me quite a bit and I began trying to make sure I chewed everything thoroughly.

I was getting depressed.  For one, the moms were leaving and that meant that I would have to be doing more as the mom of the house.  And also, it was nice to have my mommy there when I didn't feel well and my mother-in-law who is a very experienced nurse, having spent fifteen years of her nursing career doing post-op nursing.  While I like being babied and having an excuse to sit and not do any work and their leaving signaled that I would have to start doing more and more, I was suddenly anxious to be back to normal.  While I had somewhat prepared myself for a lengthy recovery, it suddenly sank in that this was vastly different from the surgeries and procedures I have had in the past.  While I am recovering quickly from the six laparoscopic incisions, my internal anatomy is different than it was before and is taking some getting used to.  Then I wondered how long things will be like this and how long til I can eat normally.  I was feeling pretty down about it.

Thursday came and I was due for a one-week post-op check by my surgeon.  I hadn't been out since I came home from the hospital Saturday and it felt a little strange driving myself to the appointment, since I still didn't feel so well.  But, it was good medicine to get outside and breathe the fresh air and see the sun.  It lifted my spirits considerably.  The surgeon said that my incisions looked good and I was free to get in the tub or the pool.  He asked me how eating was going.  When I told him about the incident the previous day, he said that it would likely get better in a week or two.  He wants to see me back in six weeks.  He said that obviously they tightened up the opening to my stomach, but that it should stretch some on its own.  If it doesn't, they may have to stick a balloon down there to stretch it.  Doesn't sound like fun at all.  I asked him if it was normal for me to have difficulty drawing a deep breath.  He said that since they had been working around my diaphragm, that was normal and that my lungs sounded clear.  We talked about the miscommunication at the hospital and he jotted down some notes to speak to the chief nursing officer himself.  They weighed me and I was down 5 pounds since surgery, 21 pounds total since I started my Weight Watchers diet a couple of months ago.  I was surprised at my weight in the hospital because for the weeks prior to surgery, I ate whatever I wanted to since I knew certain things wouldn't be allowed post-op for a while.

After the doctor's appointment, I picked up McDonald's for the family and ate a cheeseburger over the course of two meals.  I'm eating several small meals throughout the day, as opposed to three large meals.  Since I can't eat a lot of the things that my family is eating, my meals don't seem to disrupt them very much.  For dinner, my husband got Popeye's chicken and I had mashed potatoes and then tried a biscuit.  I got about halfway through it and realized it wasn't going down and thought I was going to regurgitate it again.  I managed to get it down, but I was pretty much done for the night.  I have realized that I not only have to chew things thoroughly, but I also have to eat slowly and pause between bites to give the food a chance to get into the stomach before I go on to the next bite.  This makes eating a lengthy process for me, so I don't eat much even if I am feeling hungry (which I usually am not) because it takes too long and the food is cold before I get done.

In other news, while my incisions are healing, it is causing supreme itching of my abdomen, so I am slathering it with lotion or putting ice packs on it to control the itch.  I have a couple of large blood blisters near my incisions that my mother-in-law called "instrument bites"--my surgeon tried to tell me that it was from the tape causing skin irritation!  My stomach rumbles a lot and every time I move around, I belch over and over and over.  I meant to ask the doctor how long I can expect that to last, but I forgot.  I had thought I might have problems with my bowels since I was taking narcotics which cause constipation, so the day I arrived home, I took a stool softener.  But, the next day I had diarrhea and have had it ever since.  This is not totally uncommon with me since I have IBS, but somehow, though I can't put my finger on it, it's different.  I am hoping that my next report will be full of good news!

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