Saturday, July 5, 2014

Awake During Major Surgery— Part 3

I lay on the operating table watching the screen off to my right that showed the procedure to remove a huge uterine fibroid and adenomyosis in progress.  Actually, my surgeon had speculated that I was suffering from adenomyosis.  If indeed it was present, he would see it and would also have the lab confirm it.

In the twelve centimeter opening on my lower abdomen, I saw some adipose tissue (fat) and was so pleased to see it taken away.  A minor tummy tuck.  That has to be a bonus, I thought, feeling comfortable and quite enjoying the show.  I felt a tug as an instrument held the entrance to my guts open wider, but it was not distressful.  Fascia, sheaths, and connective tissues were separated from my muscle and then the muscles were pulled to the sides.  Old blood from hemorrhaging was there and they squirted what I guessed was saline water into the wound.  Often in the past months I had been sure I had suffered blood loss by how I felt, yet there was no evidence at times.  The blood had just stayed inside me.

The surgeon put his gloved hand into the hole that presented itself.  All of a sudden, out of nowhere, I felt nauseous.  The rush up my front quickly turned to a panicky feeling.  I could not understand why I would feel panicked when just a second prior I had been thoroughly enjoying myself.  I thought, Well, I guess I can’t handle this.  In disgust, I looked to the anesthesiologist and was about to tell him I supposed I needed general anesthesia when he came close to me and told me what was happening.

“The epidural made your blood pressure drop.  I’ve already given you something to raise your blood pressure and to stop the nausea.  You should feel it take effect soon.” 

Before he had stopped speaking, I felt blissed-out again, happy to get back to watching the procedure.  I was distracted, though.  It was an amazing thing to experience drugs at work.  With the sudden blood loss and anemia of months prior, I had experienced my blood pressure drastically dropping and had taken herbs to help get things closer to right again.  This was my first time experiencing my blood pressure dropping due to a drug.  (For two days to come, I would experience my blood pressure dropping suddenly, causing me to vomit and postpone walking.)  The speed with which the nausea and panic left amazed me.  I also truly felt that this doctor by my side had my back.

I had missed some stitches sewn into my uterus, leaving threads.  The surgeon and his assistant were pulling it up by these threads.  It took up the entire hole as it flopped onto my abdomen.  They had placed a tourniquet on an end of my uterus and injected what I thought to be a stop bleeding drug.  Truly, I needed a program!

I saw some blood on the outside of the uterus and now my uterus rested on white cloths which had been placed on me, completely covering all of my skin.  A laser was used to cut the uterus in half vertically.  I knew the integrity of the uterus had been compromised since horizontal cuts were better.  I also knew that if the surgeon had chosen a vertical cut, the fibroid’s placement would have required it.  As it opened, I could see very dark blood clots and assumed adenomyosis was indeed present.  (Endometrial cells swell with blood and cause bleeding-thus, the clots.)  I could see the fibroid’s shape hidden within a layer of the uterus.  It was huge, like a softball.  A tool was used to make multiple punctures into the uterus or fibroid.  When the fibroid finally came out, I saw it in the surgeon’s hand.  He could not close his fingers around it.  (It was really the size of a baseball, but part of my uterus had come with it, making it seem larger to me.)  As with the blood clots and such, it went off to the side out of my view.  (The fibroid turned out to be housing thirteen fibroids.)

I saw debulking occurring.  During my visit to his office when contemplating this procedure, the surgeon had told me that if adenomyosis was present, the upper third of the endometrial layer would be removed.  I watched him shave away the top of both halves and watched a part of me thrown to the side with the fibroid.

I could smell flesh burning when a laser was used prior to the uterus being sewn up.  His technique of long threads making knots was cool to watch.  They both worked with amazing speed.  I marveled at how my uterus became the size of his palm, about a third of what it had been. 

At one time, the surgeon and anesthesiologist discussed the World Cup soccer matches that were presently going on.  At another point, the surgeon was trying to get the anesthesiologist to make me sleep, though he did not directly say so. 

I felt great love for the anesthesiologist when he said, “We’re cool here.  Everything’s fine.” 

Again, the surgeon tried in a secret speech kind of way that I recognized both as a parent and as a practitioner myself. 

“We’re doing great.”                

I was so pleased that I got to remain awake, but was confused as to why he felt I should be asleep.

The sewing took a long time.  It was very detailed, thorough.  (Ninety-six sutures, I later learned.)  At times, my uterus resembled Audrey as a young plant in Little Shop of Horrors.  By the end, it looked like a fish.  I saw a fibroid about three centimeters cut off the outside of my uterus and a cyst taken from an ovary.  (Blood spurted out, so possibly a hemorrhagic cyst.)  Something was also taken from each fallopian tube.  The tourniquet was removed and a lot of what I thought to be saline solution was poured into my cavity.  Tools were used to aid in the lowering of my uterus back into my abdominal cavity.

I sighed.  It was almost over and nowhere near to a four hour surgery.  I had made it!  Unfortunately; though, my peace was about to be broken once again.

I saw three huge cloths enter the cavity and only noticed two bloody and wet clothes come out.  (When watching the DVD two days later, I saw three go in and three come out.)  When the surgeon asked, “Isn’t there one more?” I could not help but nod.  The nurse started counting everything immediately.  Over and over she recounted and recounted.  Always, it was yes that everything to come out, had.  Meanwhile, though, the surgeon roughly searched for the cloth, his hand and half his forearm disappearing inside me.  At one point, I saw my intestines in his hands and thought they looked pretty healthy, though I had never seen real healthy intestines before, so I am perhaps no judge.  I had only seen those in autopsies.

Out of nowhere, a dreadful pain rushed up my front.  It culminated with my temples pounding.  The anesthesiologist touched my forehead and whispered, "Everything's ok."  (Apparently, my heart rate had raced.  Perhaps he thought it an emotional response.  It could have been a physiological response.)  Later, I asked the anesthesiologist why I felt the rummaging through my tummy, and intestines when the surgeon held them.  He reminded me that the Vagus nerve communicates with the intestines, but also with breathing.  The epidural cannot shut out such a powerful, important nerve.  After all, usually, the surgeon would not be rummaging around like that.  I was pleased he searched—better safe than sorry, because I would have been the sorry party!

The unbelievable, suffocating sensation finally stopped.  He was satisfied.  All was well.  I was so relieved. 

Stitches were made here and there as I was being closed up.  The next solution made a foam as hydrogen peroxide does.  Then, what I thought to be saline solution was also used.

Soon I was looking at adipose tissue again through a small ellipse.  He sewed the two pieces of skin that had never been joined before together.

The anesthesiologist helped me to call the nurse over with the container holding the fibroid and other waste in it.  To the diseases, I said, “Thank-you.   You've taught me a lot.”  It went to the lab to be tested.

Soon, the screen was off and the blue sheet was coming down.  I knew a nurse had placed an abdominal binder on me, even though I did not see it or feel it.  As I was moved to my bed, I felt like a head floating in space.  I said, “Weeee!”

It took three hours in recovery for me to be able to move a toe sufficiently enough to be allowed to return to my room.
My road to recovery included suddenly dropping blood pressure and vomiting...always fun on a freshly cut up abdomen...fevers that came and went,  a cough for a weekend...another joy to the abdomen...and male stalkers when out walking the streets of my home town-stalkers from whom I could not run.  But, hey, the adenomyosis is long gone and within a month, my fingernails started to grow.  (My nails showed the poor state of my blood for many months.)

Note: When you are asleep during surgery, things may occur about which you may know nothing.  For example, the surgeon's report says nothing about the search for a cloth.  It had been traumatic for my organs, and yet, there was no mention of it.  My medical report was there to list how many sutures, etc., but I think it fair to the patient to document goings on as well.  The report also said that I awakened in the operating room, yet I never slept.  My mother, who had also viewed the surgery live from our room, did comment to the surgeon that the roughness with my insides, having his arm inside me like that, might have caused some bruising that may be sore to me.  He did not think it would be.  This talk happened while I was in the recovery room.

On September 9, 2014, Temple Community Hospital was closed down due to not being up to earthquake standards.  It is a shame.  The employees at that hospital were a wonderful team.  I am so grateful that this hospital allowed the surgery that saves the noncancerous uterus. 











Friday, July 4, 2014

Awake During Major Surgery—Part 2

Fernando wheeled my gurney to the operating room hallway.  Here, people to go into help with surgeries were putting on hats and such.  Two patients in their gurneys were in a line in front of me.  I heard a new person brought up behind me.   I might have been nervous about placing my life in doctors’ hands, but these were no random people to work on me.  They were a team who had performed this surgery at least 1,500 times.   I trusted them. 

Two really nice O.R. nurses came over and introduced themselves to me.  Soon, the doctor I had been wanting to meet for days approached me and introduced himself.  This was my anesthesiologist.  I felt the conversation about how I wished to remain awake should have occurred days prior, but better late than never.  Surprisingly to me, there was to be no discussion.   

He came up to me and laid it out. “I’ll give you an epidural.  Epidurals don’t work in 15% of patients.  If it doesn’t work, I’ll have to give you a general, which will put you out.  I’ll give you a sedative soon to calm you down.”   

I felt clam and said, “I don’t want a sedative.” 

“You’ll start freaking out when you can’t feel your feet.”

“No, I won’t.  It will mean I can’t feel the operation and I’m fine with that.  I also don’t want any amnesiacs.  I want to remember.”

“Absolutely not.  I’m giving you the sedative and it WILL make you forget and that’s that.  You will not be able to lie quiet.  You’ll talk.  It’s a four hour surgery.  You won’t be able to handle it that long.”

“Yes, I will.  I had my anal sphincter sewn and a vaginal hematoma that had burst  without any pain killers at all.  No local or general anesthesia.  I had to lie still for two hours and fifteen minutes with my feet in stirrups!  I watched every bloody stitch and listened to him talking to the woman about how to sew a pelvic floor correctly.  Also, I had surgery recently. (As an outpatient.) I didn’t like not remembering and the drugs made me talkative, yet I didn’t know what I was saying.  Please.  I’m calm.  I can handle it.  I want to stay awake.”

It’s really quite unfair that a consumer who knows herself better than any of these strangers can’t be heard, I thought, hoping that he would allow me to be awake to see the disease, my tormenter for close to a year, leave my life.  Nurse Beverly had been on the phone with him the night before…He had called her…She had told him about my good spirits and I had told her I planned to be awake.  She might have told him, which may be why he was so ready for me with reasons why I needed to be drugged further than an epidural.  I lay there wishing he had chosen to get to know me better.  I can guarantee anyone that if I have a physical body to autopsy when this lifetime is over, my spirit will be standing close by observing!

People came for various gurneys.  Mine was wheeled into Operating Room A.  I saw a camera up on the ceiling, which would make the picture on the screen face from feet to head.  Odd, usually when I see my abdomen, I am looking down the direction of head to foot.  The hands that I would see on the left of the screen would really belong to a surgeon standing on my right.  The operating table I moved over to was thinner.   I had to lie on my left side as the anesthesiologist did the epidural.  Then, I rolled onto my back with my gown raised up to just beneath my breasts.  A nurse placed sticker things on my breasts and chest area going under my gown.  I was pleased that I was not exposed.  That made me feel respected and therefore, safer.

The screen off to my right up high on a wall came on pretty quickly.  On it, I saw my naked upper legs, private area and tummy.  Me in my thigh high tights and then stark naked made my Vegas joke all the more real.  Oh, my!  I thought.  I look like a show girl!  As the nurse prepared the area for surgery by cleaning me with three different solutions, I could feel the pressing in a distant kind of way.  After applied, the yellow, orange, and black ointments were wiped clean. 

The anesthesiologist moved the table to place the camera on my tummy only, so I lost the view of how they draped me and possibly placed a blanket over my legs. He put the brakes of my operating table on as a nurse was preparing my right arm.  I was as a religious prisoner of the Romans.  My right arm was out as if I was on a cross, cradled in this green foam.  Then it was covered.  I don’t think any gadgets hooked up to that arm.  The other arm was also straight out, but on a flat thing that came out of the table.  The anesthesiologist placed a catheter in my wrist.  Here, he gave any drugs he felt I needed.  I know I was hooked up at my chest, but I don’t know where else.  I knew a urinary catheter had been put into me, but don’t know when it was done.  (That was to come out on Tuesday.)  A blue sheet was being raised to create a space in which the surgeons would work, blocking my direct view of them.

I saw my surgeon behind me to my left and said, “Good morning.”  I think he grumbled a good morning, but clearly did not want to talk.  I wanted to tell him my hemoglobin was no longer 10.8.  I had told Beverly at any rate.  I was surely no worse that 9.3.  No matter.  Months earlier, when I was 6.8 and contemplating a Myomectomy where significant blood loss occurs, a drop in hemoglobin would have been significant.  With this surgery, I would lose hardly any. 

On the screen, I saw two clamps with teeth placed on my tummy, below my belly button, on both sides.  I felt nothing, so looked to my left to the anesthesiologist and had a frown conveying, Nope, I don’t feel it.  Next, I watched on the screen as the surgeon drew a line from my belly button down to my pubic bone.  Then what seemed close to my hips, he drew a horizontal line.  Soon, I had five purple vertical lines and two twelve centimeter horizontal lines in an elliptical shape. 

Then the laser.  I could smell my skin burning as he cut an oval.  The skin was thrown away.  The first of what I came with that I would soon be leaving without.

Songs from his i-Pod played over the loud speaker—like Five for Fighting.  I constantly checked to see if I could remember what just happened and what song was playing.  No amnesiacs, yet! 

It had begun…                                                                               

Awake During Major Surgery—Part 1

My first time as a patient in a hospital and I was looking forward to my stay.  My mother and I arrived at about 7:45 P.M. on Sunday, June 22, the night before the big operation which would remove the huge fibroid and adenomyosis from my uterus.  A guy checked me in by placing a bar code tag on my wrist.  It also had my name and birth date on it.  Throughout my stay, any time I received a vitamin or drug, pill or shot, the bar code was zapped with a gun that was read by a nearby computer on wheels.  Fancy having a barcode like an item at a store!

All was quiet on the third floor where we were met by an assistant nurse, Maria, who took us to our room.  The room was huge with two beds, a couch and two chairs, a private shower separate from the sink and toilet, and two TV’s.  There was also a cabinet holding another TV that was hooked up to the camera that would be over me during surgery so my mother could watch the operation without sound.

Maria pampered us as if we were at a four star hotel!  She brought us each a tray of food; though, I didn’t fancy a meal so close to having my bowel sounds disappear and I had already had some soup at home.  It was funny, when I was booking my four night stay at the hospital, I felt like I was booking a hotel at Las Vegas.  During the operation, there would be a male surgeon, a male assistant surgeon, a male anesthesiologist, two male technicians (my surgeon works fast and needs two handing him instruments, etc), and a male photographer for the stills that I would get to keep of the operation.  Insurance refused to pay for the surgeons and the anesthesiologist as they thought I should just have a hysterectomy, so I paid them 100% out of my own pocket.  My running joke became: I feel like I’m booking a trip to Vegas.  I’m going to be naked with six men, get all drugged up, and lose lots and lots of money!  The room was so nice and my mother and I were in great spirits as if we were on the Riviera, that my joke was starting to look like a reality: a vacation.

 I was busy unpacking when Nurse Beverly came to check me in—a lengthy process.   I munched away on my apple that I’d brought from home, answering questions.  Beverly commented on my good attitude and that that would help me through the process of surgery and recovery.  I was just plain sick of bleeding and constantly trying to rebuild my blood.  After ten months of being careful not to aggravate my uterus and experience more blood loss, I was literally on the verge of going insane!  The knife (and lasers) were to be a welcomed change.  My mother had her needlepoint and book, and my only obligation was to be to heal.  What a lovely break from my busy world!

I slumbered in my own nightgown, but had to change into a hospital gown before I was picked up at 5:30, the morning of the 23rd.  Beverly showed up to put thigh high white stockings on my legs that were to keep my legs warm.  Later, the compression boots would be added to aid with circulation. Each time Beverly came to me, she grabbed some gloves from the holders near the doorway.  Here she was just touching stockings, and her hands were gloved.   Old TV shows have characters taking blood and entering throats and other cavities and all sorts of things without gloves.  Beverly’s machine that digitally displayed blood pressure, pulse, oxygen rate, and temperature was certainly more sophisticated than anything I ever saw on hospital related television shows when growing up.   One thing TV does is its shows document how we are culturally at a certain point and space.  I imagine modern TV shows portray hospitals like what I experienced, including nurses in scrubs rather than the white dresses of the past.

Fernando showed up just inside my door with the gurney which I walked over to and got on feeling as though I was about to go on a fun ride at an amusement park.  I lay down and he put a blanket over me and we were off.

I was not nervous.  I was excited.  It was almost more emotion than I could bear.  No more suddenly hemorrhaging out of nowhere.   No more having to supply something on which to sit when at a fancy restaurant with cream upholstery seats.  No more avoiding tennis and ice skating and softball and running and dancing and Insanity and everything that made blood gush from the muscle layer of my uterus without warning.  Soon it would be over!

I was wheeled away from my room toward an elevator fully awake, how I would remain for the entire two hours of major surgery.

Tuesday, July 1, 2014

Abdominal Myomectomy & Uterine Reconstruction Surgery

Adenomyosis (uterine endometriosis) and uterine polyps should be the first two differential diagnoses made when a client seeks a practitioner’s help for excessive uterine bleeding with clots.  Unfortunately, doctors mostly focus on conditions like fibroids, or jump to treatments like endometrial ablation before fully understanding the situation.   Fibroids are not the only cause of excessive (both in duration and amount) bleeding and clots, yet, sometimes, they are removed only to have the problem continue.  Even worse, most gynecologists don’t truly clean out the whole uterus of its problems (polyps, adenomyosis, cysts) and later, hysterectomy may be recommended, or uncontrollable bleeding may occur during a vaginal myomectomy and then the uterus has to be removed in order to save the patient’s life.

Abdominal myomectomy means that fibroids are removed from the uterus when the uterus has been pulled up out of the patient’s abdomen, to be returned after it is cleaned out.  Unlike vaginal myomectomies, there is little bleeding, perhaps a quarter of a cup at most.  In vaginal myomectomies, only one fibroid is often removed since the ultra sound usually only alerts the doctor to one fibroid.  With the abdominal myomectomy, the doctor cuts the uterus open so is able to see and remove everything that’s not supposed to be there: fibroids, adenomyosis, etc.  also, fibroids on the outside of the uterus are easily seen and removed.

The surgery for a vaginal myomectomy most likely leave fertility intact, where as with the abdominal myomectomy, the possible vertical cut of the uterus or the removal of certain adenomyosis cells will destroy pregnancy hopes.  However, those with adenomyosis in the uterine muscle layer will already have compromised fertility without knowing it.  Endometrial cells swell with blood even when they’re in the wrong place.  In the muscle layer, this means hemorrhaging drowns the muscle cells, which means that if there’s a pregnancy, the uterus will only grow so far before it ruptures, killing the woman.  Therefore, a woman with undiagnosed adenomyosis may go in for fibroid removal via vaginal myomectomy and be unaware that she should not attempt pregnancy.  Sooner or later, the bleeding and clots will be noticed and the presence of fibroids will be suspected.  (Most gynecologists don’t test for, nor mention adenomyosis as a possibility, yet they know they read it on the lab report of those women who have had hysterectomies.)  These poor women are subjected to further vaginal myomectomies until hysterectomies are recommended.  The unsuspected adenomyosis can be removed via abdominal myomectomy.  Women do not have to lose their uteruses in order to stop the dangerous bleeding.  Abdominal myomectomies can be performed by Dr. Del Junco, who is not a gynecologist.

Pelvic reconstruction surgery occurs immediately after the uterus has been cleared of all fibroids, adenomyosis, cysts, polyps, and blood clots.  It is sewn up inside and out and then replaced in the abdominal cavity, much smaller than before.  Only healthy tissue remains to take the woman into a normal menopause and to occupy the space the uterus was intended to occupy—rather than fallen intestines and such which may occur in a woman who has had a hysterectomy.

If you have been diagnosed with fibroid disease, I highly recommend you try to figure out if you have adenomyosis as well.  No matter which treatment options you feel are right for you, you want to also make sure that you are being fully diagnosed.  If your doctor is telling you that a fibroid has to come out immediately and that you may need a hysterectomy, please consult another doctor.  I had a fibroid the size of a baseball, and Dr. Del Junco rightly thought that the fibroid was not the only thing causing my  troubles: adenomyosis was.  Don't accept a doctor telling you that you don’t need your uterus.  That only shows ignorance on their part. 

7/6/2015: If I could go back two-three years, I'd start taking Dr. Theresa Dale's homeopathy as well as other things.  I'd also do anything to get out of stressful situations.


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