Now that the laparascopic cholecystectomy is finished I thought I'd share a few afterthoughts and insights in case others have to get it. (An estimated half million Americans get their gall bladders removed each year and some estimates go as high as 600,000). Many others prefer to gamble with gallstones remaining in their gall bladders, opting to get them removed by endoscope periodically (cholecystostomy). But this is playing a kind of Russian roulette with your health. You are basically risking everything from a burst gall bladder spewing contents into the abdominal cavity (and peritonitis) to pancreatitits and gall bladder cancer.
The surgery, as depicted in the previous blog (in a youtube video) is simple, with 4 small cuts generally made, I believe a lot of the post-operative results depend on which hospital you go to. The possible complications, which you're alerted to, include: blood clots, stroke, heart attack, pneumonia, infections and bleeding. Of course, as in the case of side effects for drugs providers are obligated to always give the worst outcomes - just in case. Fortunately, the only mild complication experienced was bleeding from the wound but this abated after applying intermittent pressure.
Anyway, these are the highs and lows I experienced in the course of the Monday pre-operative prep, surgery and release.
1) The friendliness and efficiency of the hospital staff which definitely inspired one's confidence.
2) The extent of redundancy in the hospital's entry and recording systems -including generating multiple name labels for placement on everything you can think of, to make sure the surgical care personnel know exactly who you are and don't perform the wrong surgery. Also, generating a bright red allergy alert tag to alert the anesthesiologist. (In my case, allergic to versed, Statins and shellfish).
3) The friendliness of the surgical pre-op preparation Nurse who escorted us to the surgical prep room, laying out my surgical gown (hate those damned unisex things, but what can you do?) and then giving me ample time to get into them, with Janice's help. She then returned to ask detailed questions on any allergies, and the last time I'd take any supplements or medications.
4) The genial atmosphere as the surgeon appeared just before being wheeled into the OR. He joked that the IV would soon be taking me "back to the islands" as the sedative was released and he wasn't far wrong. Almost like having a rum and coke, and I felt immediately more relaxed - I believe my BP had definitely gone down from its initial 137 over 87. (This despite taking my BP med just hours earlier, as directed).
5) Wheeled into the OR (No. 9) by another nurse, I was then introduced to the surgical staff and eased from the roll-in stretcher to the operating table. The anesthesiologist (who interviewed me after the nurse about similar issues and sensitivity to drugs) then attached the IV to deliver propofol and attached the breathing mask. I felt a light sting around the head and then it was lights out.
6) Coming back to consciousness is also kind of a high, as you note the gradual enhancement of awareness of your surroundings - but hear voices, machines (in the PACU, post -anesthesia care unit) as if they are happening to another. You hear yourself speak - asking the attending RN if you can have ice chips (your throat is sore and parched after hours with no liquid) but still aren't sure if it's really you or the voice is coming from someone else. This I've found one of the odd offshoots of general anesthesia - also the loss of time. It's like you didn't exist until you come out of it.
7) The attention of all the nurses to every patient's pain level and the immediate response adding pain killing meds to the IV. I had reached a max. level of 3 out of 10 which then subsided. I then had to have an O2 mask attached - owing to low oxygen in blood thresholds. This also delivered a high and sped my recovery of awareness until by 11: 40 I felt like I was an integrated person. (If that makes any sense. It may not for anyone who's never had general anesthesia.)
8) Being wheeled from the PACU to the patient recovery room, and the instant care and attention to my comfort delivered by the nurse. She also brought me a large container of water with straw to sip on and Jello custard. I began to eat just as Janice also arrived, and it hit the spot.
9) Sharing the last hour there - as I met my critical thresholds (e.g. being able to eat and drink, urinate) with Janice - who also helped me to get dressed, as I was still dizzy (high?) from the anesthesia.
10) The pain level never remotely approached a '10' and on leaving when the RN offered a full gram of Tylenol I only took a half of that. I was also prescribed hydrocodone for the post -surgical pain by the surgeon, but haven't had to use it. To me, with the massive pain killer abuse in the country, that was also a definite high.
1) Having to complete an 'Advanced Directive- Living Will' and have it scanned into the system. Of course no one likes to think about it, but with any surgery there are risks - as well as from the anesthesia. Bottom line, you may not emerge from it 'whole' either in body or mind, so what would you like done if that's the case? To what extent do you want life-saving measures delivered, e.g. cardiopulmonary resuscitation, breathing machine, feeding tube, dialysis? The purpose of the living will-AD is to let the staff know, and also when to pull the plug. (In my case, it was definitely if no EEG signal was detected, or if I was unresponsive for more than 24 hrs.) ). You are reminded, in other words, of your mortality, but that is a good thing - and look, too many Americans don't have any regular wills, far less living wills.
2) The feeling of nausea - a reaction to general anesthesia - just as you begin to 'surface' in the PACU. You can feel it coming on, you're barely aware of your surroundings, but the RN checks the monitors - asks if you're nauseated- you nod and she delivers the appropriate med.
3) Lack of diverse snack offerings in the patient recovery room (where you eat and drink just after arriving from the PACU). Basically, these are the choices offered: Jello custard cup, cherry Jello cup, Saltines, cheese sticks, peanut butter graham crackers. I basically settled on just the Jellos - also only water, none of the sweet juices.
4) The effects of the anesthesia on your brain. Basically, you get "anesthesia brain' lasting from 18 to 24 hours, for some people longer. Your words come out in the wrong order, you are unable to recall the appropriate words - nouns and verbs - when trying to form coherent sentences, and you experience memory lapses - like where the hell you put your belongings. (Not those in the hospital, those get bagged securely, but your belongings at home - like Ipod, wedding ring etc.)
5) Dealing with oozing wounds. The pain, as it turned out, was -is manageable using just ibuprofen. But the main post-surgical issue was blood oozing from the umbilical incision from which the gall bladder was pulled, along with a 1" stone. (See surgery video for reference). We phoned the surgeon the same night and he said it happens to some people - after all the wound is only sealed with super glue and a sterile strip, no stitches, or staples any more - so you need to apply pressure at 5, 10 minute intervals.
6) The unbelievably painful sore throat (at 7 out of 10) following the anesthesia wearing off. It was so sore I could barely talk. Definitely a result of deep intubation of my throat to enable breathing but likely "scraping off lots of throat tissue" (in the words of a friend in NC who had the surgery 3 months ago). His solution? A teaspoonful of honey taken directly every few hours. It worked.
7) The maddening itch affecting the lower abdomen - which had to be shaved prior to the surgery - but which is now growing back. (Only solution is to rub hydrocortisone ointment onto it.)
8) The gall bladder may be gone but you still need to control fat intake. It bears noting that - as most medical sites point out - the reason most folks have gall bladder attacks in the first place is because of a fat-heavy diet that also spawns high triglyceride levels and a "fatty liver". Before, the gall bladder had acted as a kind of "filter" with the fats ingested, but now - with it gone - you need to exercise even more care in what you eat.
I wrote (8) as a negative because I've always been a lover of bratwursts, chicken wings, pizza, and Nathan's hot dogs - as well as my Grandfather's Croatian stuffing. But let's concede it can also be taken as a positive if it leads to better general health, lower risk of heart attack, diabetes etc.
My follow up appointment with the surgeon is scheduled for May 24 when he will look at the super glued wounds and decide if I still need the special bandages covering each incision.
Contrary to a common misperception, there is more than one way for the laparascopic cholecystectomy to be performed. For example, the 4 incisions don't have to follow the exact same pattern, i.e. as shown in the video. In my case there was one umbilical incision, through which the gall bladder was extracted, a sternal incision and two side incisions. The incision pattern often isn't placed until the abdominal cavity is viewed through the camera. The gall bladder can also be extracted through an incision other than the umbilical, for example there can be a sternal extraction - as a friend in NC had. The location is determined by the surgeon based on which incision site enables the easiest access to the organ.
All for now. New blog post maybe in the next two days - after I pass one more post-op hurdle.