Surgery

I finally took the plunge. Surgery. Here I am at about 6:15 am, ready to go back. My girls Katie and Laynie were with me, and they forgot their cameras... good thing for phone cameras! I wasn't nervous yet. It didn't hit me until I walked into the OR.

Hazel, an anesthesia nurse, had started my IV. She signed and dated the tape. It HURT! Worst IV yet for me. She also took some blood from the crook of my elbow. That didn't really hurt. Too bad she didn't know to do that before she had my IV all taped up. The blood was for Dr. M-the-GI-guy's research study.

Let's get this party started!

I'll go ahead and apologize for a long post now. I've got nothing else to do today, and this is like my journal entry.

They wheeled me on my bed to the OR, and stopped outside. They had me get up and walk in. That was when the emotions hit. I realized it was really going to happen. I felt the tears welling up. The anesthesiologists were getting the table ready for me to get up on it, and I looked around the room. A little. I avoided looking near the table, because I didn't want to see any instruments. But I saw the radio in the corner. The room was big, and the table was small. I told the anesthesiologist (the REAL one, not his resident, who was more nervous than I was) that I was kind of scared. He was very reassuring and had me get up on the table and stretch out my arms onto the arm boards. Somebody put a pillow under my knees. I could see the strap they were going to use to keep my legs on the table, but she didn't put it on yet. The anesthesiologist said he was going to give me something to relax me. I do not remember a thing after that. I suppose that he didn't actually put me out yet, because the surgeon wasn't even in the room, but I don't know.

Dr. M-the-surgeon removed my gallbladder, which turned out to be badly diseased. It was contracted. He also removed my appendix, which was totally fine. I guess he figured as long as he was in there... Well, I had known that he probably would do that, because he put three procedures on the informed consent form: laparoscopic cholecystectomy, EGD (meaning upper endoscopy), and possible appendectomy. I signed it without looking. I was signing a lot of papers. Later (this is going back to before the surgery, obviously), a nurse brought it to me to verify my signature and read off the procedures. I was like huh? Whatever.

Dr. M-the-GI-guy was right: I did have actual reflux (the surgeon thought I was confusing heartburn with gallbladder pain), and it was a separate problem. I knew I liked that guy. He was smart. Dr. M-the-surgeon saw reflux during the endoscopy, even though I had taken Prilosec the night before and that morning. He did not see evidence of Barrett's esophagus, but he took biopsies. He also took biopsies from my stomach, and did something that will test for H. pylori. He found that I have a small hiatal hernia. I also have a grade II lax GEJ sphincter (that's the lower esophageal sphincter on the hiatal hernia picture). I wonder how many grades of laxity there are. Anyway.. that explains the reflux.

I had a tough time waking up from the anesthesia. Of course I was really groggy, and my eyes didn't want to open. The first thing I registered was pain--on my face! My cheeks and lips were burning. Darn Accutane has made my skin so sensitive. I think I've written before my Aquaphor addiction. As I woke up, the oxygen mask was only making my cheeks hurt worse, and I began to cry. The nurse (my best nurse out of the four I had) came over to see what was wrong, and I tried to sign pain and thirsty, and she didn't get it. Actually, I didn't even mean that I was thirsty. I meant dry, but somehow I signed thirsty. My brain was a little addled. The nurse seemed to think I was randomly moving my hand, and she kept asking me what was wrong. I finally realized that I was signing and of course she is not going to understand, so I whispered, "Vaseline. Dry." That's right, my first word upon waking up was not Mom, Dad, Katie, or Laynie... It was Vaseline. The nurse noticed the rash all over my face and got worried. She smeared Vaseline on my lips (sweet relief!) and had the post-anesthesia doctor, Dr. S, look at my face. They were getting kind of worked up about it, so I must have looked awful. I kept trying to say Accutane, and finally they got it. They put bacitracin on it and I felt much better. Except that my stomach hurt and itched. I asked what time it was: 11:30. I had gone into the OR at 7:15. Later I found out that I came out at 10:58. I guess I was under the knife for three and a half hours.

The surgeon came by to see me, and he told me that he removed my gallbladder, which was quite inflamed, and my appendix, which was healthy. Prophyaxis, you know. The more I think about it, the happier I am that he did that. That was all he said. A few minutes later, the anesthesiologist came by to see how I was doing. After he left, I was not doing too badly, and they were going to get Katie or Laynie to see me. The nurse came back to say that they weren't there. I figured they were still at audiology, because Laynie had a mapping appointment. I didn't care anyway. I didn't have a desire to see them. It wasn't that I actively didn't want to see them, I just didn't care. Then I felt like there was junk in my throat, and I had to cough. I had trouble coughing it all up, and I ended up making it worse for a while, and I couldn't breathe. The monitor was blaring its warning, and the nurse helped me sit up to cough it out. Finally I did, and I laid back down. My throat was so dry. It hurt to breathe! Every breath felt like little knives stabbing the back of my throat. I started to cry, and the nurse wasn't able to help me feel better, so she went to get Dr. S. I wanted to stop her, because I knew the doctor couldn't do anything about it. But I couldn't exactly yell after her. I could barely whisper.

While the nurse was gone, my throat began to settle down, and I wasn't feeling too horrible. But then I started crying uncontrollably. It hurt to cry, but I couldn't stop. Dr. S came, and I told her that I was fine, but I just couldn't stop crying. She and the nurse went out to the other side of the curtain to talk. I could hear them just fine. Dr. S said that the medicine (from the anesthesia?) was making me cry, that it would probably continue for a while, and just to reassure me. I opened my eyes and smiled at the nurse to let her know that I heard everything (still crying, ha). She came over and told me to get some rest. A few minutes later, the creepy crawlies started.

I felt like something was crawling under my skin, all over my whole body. I loved the pressure from the leg massager things, which were on my lower legs. I wished I had those all over. I kneaded my hands into the bed to try and get some pressure, wondering if this was how sensory disorders feel. This is going to sound crazy, but I reeeeeeeeeally wanted to beat my head, like just hit it with my hand, because I thought that would make the feeling go away. I didn't, because I figured the nurse would flip out. It was hard to contain that impulse, though. Finally, I fell asleep, or at least into a haze. I could hear the conversations around me. The guy in the curtain area next to mine had had some malignant tumors removed from his lungs. His family was loud. I wanted them to be quiet so I could sleep. I think I finally did sleep.

At around 1:30, I woke up doing a little better. The creepy crawly feeling was gone, whew. After a while, the nurse asked if I wanted to see my family, and I said OK, but my voice didn't work. She understood my mouth movements, though. Katie came to see me, and I still couldn't talk. I just couldn't get my voice going! I decided to sign. Poor Katie. I didn't have great motor control yet, and I was signing with only one hand. That conversation was basically one big miscommunication. She told me that the surgeon had spoken with them, that he removed my gallbladder and appendix, which I knew. She also told me about the hiatal hernia, which was news to me. She said that hiatal means small, and I tried to tell her no, hiatal is referring to the location of the hernia, as opposed to an inguinal hernia, etc. But I had more language inside than I could really express. Katie didn't understand me. I'm sure my fingerspelling was horrible. I tried to ask if I needed surgery to fix the hernia (thinking about my friend Deb from work, who had a hernia repaired last year), but Katie thought I was talking about pooping. If you know ASL, you will understand why confusing surgery with poop is a perfectly reasonable misunderstanding. I started getting my voice and the nurse came over. She was confused, to say the least! Katie left, and the nurse said, "I talk and you respond.. I talk and she responds.." Haha, I told her that we are both hearing, but we were just signing. Come to think of it, I don't know why Katie was signing back. My ears worked just fine. Putting out what she was taking in, I guess. I think Katie left pretty frustrated.

A little while later, Laynie came back to see me. I don't really remember much, except that we communicated fine. Laynie just reminded me that she was the one who told me that I only had two holes: an umbilical incision and a shorter incision (punture?) under my right ribs. I was surprised and didn't quite believe her, because Dr. M had said he would make three punctures and an incision. The nurse said, "Yeah, I think there are only two--I was looking for them before." Eh? When I was out? Haha. So she looked again and still only saw the two spots. Wow.

I've said a few times that my mouth was dry--this is something I struggled with all day. The nurse swabbed my mouth with water every now and then, but I was breathing through my mouth (guess I didn't need the cannula on my nose), so it kept drying out. I wasn't able to eat or drink yet. One thing I noticed was that I was aspirating the bits of water that would run down into my throat. I was hoping that a larger bolus (bigger swallow) would help, and I didn't worry too much about it.

Katie and Laynie took turns visiting me all afternoon and evening. Laynie took this picture of Katie in the waiting area. Little techie girl.

Of course, they wanted to get me up and eating, drinking, going to the bathroom. All of a sudden, I really needed to pee. Laynie was with me at that point. I wanted to try and get up to use the bathroom. When the nurse sat my bed up, the room spun. It spun more when I tried to sit on the edge of the bed. I wasn't able to sit up straight, and I wanted to lie back down. I just wanted them to leave me alone. All of a sudden I did not have to pee. The nurse got a wheelchair and was locking the wheels when the room spun again and a wave of nausea washed over me. I leaned against Laynie and began to cry. I told the nurse that I was nauseated, and she laid me back down and went to get medicine for that. First she had me use a bedpan. Weird. Then she got the medicine ready, warning me that it was going to make me sleep for a few hours, but I would feel much better when I woke up. It was called fenerdyl or fenerfen or something like that. The nausea subsided as soon as I laid down, but I wasn't thinking clearly enough to connect the nausea with the room spinning, so I didn't stop her from injecting the medication into my IV line. Within 10 minutes I was in a stupor, but it took a long time for me to fall asleep. I kept hearing conversations around me and machines beeping.

I woke up around 5:00, and Laynie was there again. I had to pee again, and they tried to get me up again. Same thing: the room spun and my stomach spun with it. All of a sudden I had a word for it: vertigo. I told the nurse that I was feeling nauseated and couldn't get up to use the bathroom, but I didn't think I needed nausea medication. I tried to explain the vertigo. She gave me nausea medication anyway, but a different one, which would not make me drowsy. I was fine with that. But I still wasn't able to get up, and I had to use a bedpan again. Then the nurse kicked Laynie out. That nurse kept kicking them out.

I wanted to get up, and of course everyone wanted me to. I was learning that if I fixed my eyes on something directly in front of me, the room would not spin, or at least not much. So I sat up in bed for a while, practicing that, and then I asked the nurse to help me to a chair. Oh, man, did my stomach hurt when I stood up! And it hurt sitting in the chair. The nurse offered to put my legs up, which helped tons! Dr. S came by to discuss pain, and I told her that I was having quite a bit of pain, maybe a 7/10. But I did not want something that would make me dizzy or lightheaded. I agreed to take IV Tylenol. I think it was called Toridol. It didn't really help, but I have a decent pain tolerance, and pain wasn't my main concern at that point. Pain wasn't what was keeping me from going home; vertigo was.

The nurse wanted to get me eating and drinking, and I was definitely down with this plan. It was about 5:30 by this time. She offered Pepsi or Sierra Mist, and I chose Sierra Mist. I would never drink caffeine. She was gone for a while, and Katie was there by that time. The nurse said, "OK, here are your crackers, and here's your Pepsi." Apparently they were out of Sierra Mist. And I had to drink something carbonated to try and get some of the air out (they pumped me full of air for the laparoscopic procedure), so water was out. Oh boy. There was no way I was drinking Pepsi. I knew it would all work out. Of course, Katie offered to buy Sierra Mist from the vending machines in the waiting room, and the nurse thanked her. Katie was gone for a while, reappearing with fruit punch. As in, non-carbonated fruit punch. The machine with Sierra Mist wasn't working or something. The nurse rejected the fruit punch and was ready to give me Pepsi. This was a different nurse, actually, the only one whose name I got. Earl. Big guy. At first I wasn't too sure about him, but I ended up liking him. I explained to him that I could not drink caffeine, and he was fine with that. Katie texted Laynie to get something carbonated for me. About 10 minutes later, Laynie texted back that someone needed to watch the bags if she was going to go looking for more vending machines. That whole time we had thought Laynie was off getting my drink, but I guess the texts took a while to be received. So I sent Katie out to the waiting room. It felt like forever before Laynie showed up with Sprite. She had had to go all the way to the cafeteria, which is two buildings away! I really appreciated that.

I got to drinking, and just as I had feared, I aspirated with every sip. Small bolus... large bolus.. it didn't matter. Chin tucks didn't help. "Hard and fast" swallows didn't help. I wasn't aspirating the entire bolus, but a little bit with each swallow. I was able to cough it back up every time, though (although I would often reaspirate it when I tried to swallow it again). I told Earl that I was aspirating, and he asked me what I thought was happening. He knew I was a speech pathologist, and swallowing is within my scope of practice. I paid closer attention. I thought it was a problem with the pharyngeal phase. When I put my hand on my throat during the swallow, I could feel my larynx elevating. But was it enough? Or maybe I wasn't adequately clearing the laryngeal vestibule--what most people would think of as the back of the throat. I could feel liquid still there after a swallow. Maybe the upper esophageal sphincter was snapping shut too quickly, before the entire bolus was in the esophagus? Maybe I the problem was really with the oral phase of the swallow, that I wasn't pushing the entire bolus back. What I wouldn't give for a barium swallow or FEES, just to satisfy my curiosity. Well, it's not worth it just for curiosity's sake.. but you know. I'm nerdy, what can I say?

It wasn't just the liquids either: I aspirated some crackers, as well. I had to laugh when I coughed after swallowing crackers and chewed up cracker hit the back of my hand HARD. It was like in the movies when a person is choking and someone does the Heimlich. I figured all of this was due to the anesthesia or maybe the intubation. Earl told Dr. S, who came over and was concerned. She checked my chart and noticed that I was an easy intubation. She considered keeping me NPO (which would have meant that I would have to stay in the hospital, I think), but she ended up letting me keep trying to eat. She said it was because I was an SLP and she trusted my judgment. Hm. I kept trying to eat, and I kept coughing after each swallow. The more I coughed the more my stomach hurt. My regular nurse (Earl was filling in for her because she was busy) came over to check on me. I told her that I was aspirating, and she said, "Oh, I'm sure you're not really aspirating. You're sitting up, so I know the food is going the right way." She was exactly the kind of nurse that drove me crazy during my hospital internship, because they send people home who are at risk for aspiration pneumonia! Nurses have to refer when patients are aspirating, so that the SLP can at least to a bedside swallowing evaluation. I explained to her that you can aspirate sitting up, and I am. She went off to find the doctor, still think she was right. She came back a little more contrite.

My surgeon walked snappily by at one point and asked how I was doing. I told him I was fine except that I was aspirating. He said, "You're dysphagic?" and laughed. He asked Earl to get me a spirometer, reminding me that I should know what to do with this, being an SLP and all. He wants me to use it to monitor my lung capacity and to work out my lungs. He said he would trust me to call if I needed to see an SLP. He was giving me a hard time about being an SLP with dysphagia.

After my adventures in aspiration, I wanted to use the bathroom. I asked Earl to help me. He went and made sure the bathroom was empty (smart), then came back to help me up. I still had vertigo, but I was getting better at finding a spot to focus on, which kept the room from spinning. Much. I crept very slowly to the bathroom, holding onto Earl. I noticed that he had placed a seat cover on the toilet for me. Thoughtful. I went a little faster on the way back--maybe a turtle's pace instead of a snail's pace. Turns were tough, but spotting helped. I finished my crackers and most of my Sprite (coughing all the time), and then it was time to discuss my release. Yes!!!

Earl was so sweet as he wheeled me down to where Laynie and Katie were waiting with the car. He warned me which way he was going to turn, so that I could find a spot to focus on. It worked, and the world didn't spin much.

Hooray, home! My vertigo was a little better. I was able to move my head about 30 degrees without things spinning, as long as I kept it level. Looking down was the worst. No, looking diagonally downward was the worst. We left the hospital at 8:00, and I was in bed by 9:30.

I got up about every two hours to use the bathroom. The pain was getting worse all the time. I had only taken Tylenol or ibuprofen since 6:00 pm. Dr. S said that the oxycodone that I got would help with incision site pain, but that Tylenol or ibuprofen would be best for crampy, internal pain. I occasionally felt a breathtaking stab of pain at my incision site, but mostly bad crampy pain. It was worst when I was standing. My whole stomach felt to tight. Still does, actually.

I got up at 5:45 and ended up taking oxycodone around 7:30. I'm not sure it helped. I think just sitting still helped. I have a low dose of oxycodone anyway, just 5 mg. I had a bad reaction to codeine in the past (it made me puke), so the doctors were playing it safe. I have 90 pills (89 now), but I doubt I will take more. At least it didn't make me puke.

Now I'm in a weird position. My brain is active, since I'm not on narcotics. I feel fairly decent, except for abdominal pain. But I can hardly walk. So I can't do anything! I think I will be tearing my hair out this week. I have never experienced anything like this. Normally if I am sick, I feel tired (which I am, but not too badly--just one nap today), light-headed, dizzy. You know. So I don't want to do anything. But now I want to do stuff but can't because I can't move well and I have all this pain! It's just weird.

So that's what happened. Wow, it has taken over two hours to type this blog post! My butt is asleep. Time to go.