Tuesday, July 26, 2011

Surgery #1- What to Expect: Tubular Sensations

I have been thinking that it might be helpful and informative to review the procedure for the first surgery for those of you going through this, or for those of you that are just simply interested. Although my surgeon is wonderful, he did not go over many details of the surgery before I went in and I was maybe in a little bit of shock when I woke up from the anesthesia to find certain things poking in and out of my body. Since this first surgery is such a major undertaking, it is difficult, I think, for the surgeon to really cover everything. In this blog I am just going to go over the tubes. In the next one I will go over some other details. So, here is what you can expect:

Stuff that will be poking in and out of you when you wake up in the PACU:

1. A Foley catheter (this is a tube inserted into your bladder to drain your urine. The urine collects in a container on the outside of your body. This will still in place until several days post-op. It does not hurt to remove, nor does it hurt when it is in).
2. A second two-pronged catheter (the placement of these catheters will be the first phase of your surgery. A urologic surgeon will put these in place. They are meant to mark your ureters so that the colorectal surgeon does not damage them during the surgery. These will stay in place until a couple of days post-op. They are very uncomfortable to remove, but the process is quick).
3. A nasogastric tube (A tube inserted through your nose and put down into your stomach, this will drain the contents of your stomach into a container outside of your body). This may or may not still be in when you are in the post-anesthesia phase. Mine was taken out during surgery, only to be put back in on two different occasions while I was very much awake. It is worth discussing with your surgeon the possibility of leaving the NG tube in post-operatively. While the tube is definitely uncomfortable to have in, the worst part is the process of it going in. Better to do this while you're unconscious if you ask me, but if you're post-op, you will be awake). I spent most of my time in the hospital either telling tall tales to avoid having the NG tube put in, or desperately trying to convince my surgeon (or any other poor soul that happened to walk into my room) to take the tube out. Ask for some Ativan. NG tubes may induce severe anxiety.
4. A sump (A sump is a large drain [larger than a Jackson Pratt drain] that is placed through an incision on your abdomen into your abdominal cavity. It will drain the fluid build-up in your abdominal cavity and will be left in until several days post-op. The sump just feels downright strange when it is coming out, but it is not painful. My fiance looked on as they took this drain out and he exclaimed, "Holy cow! How long is that tube! I didn't even realize her abdominal cavity could be that deep!") In other words, you may want to close your eyes. The hole left from the sump will not be sutured or stapled shut. It will slowly close on it's own. Do yourself a favor and don't look at it the first couple of weeks… unless of course you're some kind of sadist.
5. The ileostomy (This is far and away the most shocking thing to see when you wake up. You knew it was going to be there. Seeing it is very different than imagining it. It took me several days to be able to look at the stoma [part of your small intestine that will be sticking through an incision in your skin, your stool will collect in an ostomy bag that is placed around the stoma]. This will stay on until at least 12 weeks post-op. May be longer depending on your personal circumstances. I would very much like to stress that while this will be difficult to see and confront at first, but you will learn to love this thing. You have to remember that you are having this surgery because you were very sick. The ileostomy will change your life almost immediately. It will allow you to live. The ileostomy can only be reversed surgically).
6. An epidural (This is a catheter that is inserted into your spine. It is used to localize your pain medication so that you do not become nauseous, dizzy, or high. Sometimes, you will wish you were high, but overall the epidural is a good thing. I had severe hypotension and vertigo from the epidural and so I was not able to get out of my hospital bed until the epidural was taken out 4-5 days post-op).
7. An IV (or maybe even 2) (Ok, duh. Everyone in the hospital has an IV. I had two because of my Portal Vein Thrombosis, blood clots in the vein leading to the liver. They needed to have me on a heparin infusion 24/7, so a second IV was necessary to give me all the other fun stuff. This will stay in until you sign your life away upon discharge).

The bottom line is you will have anywhere from 5-9 tubes sticking out of your body, most of them necessitating collection bins around your hospital bed that will be filled with a rainbow of different colors. Well, it's more like a very sick rainbow of very dull and disturbing colors, but if you eat a blue-colored Blow Pop, your NG collection tube will collect a very bright and cheery color.

The important thing is to stay strong. It will be scary seeing all of this, but you must know that it will all be gone soon and it is all part of the road to a strong and healthy life!

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