Recovering from Surgery - April 10-13, 2008
Post-surgery there are a number of things to deal with. The top matter of strategic importance is that my "bouncing baby tumors" were sent to a lab for analysis. The lab can determine how deep the cancer has penetrated to confirm the doctor's suspicion that the cancer is non-invasive. They will also rate the strength of the cancer, high, medium, or low. This process is called "staging" and uses a standardized alphanumeric system that will be explained later, when we get the staging. Jackie, the surgical coordinator, says it takes 3 days for the lab to get the results back to them, so that would be on Monday. According to Dr. Chuck, these things are NEVER discussed on the phone. I called Dr. Hopkins' office on both Thursday and Friday and asked for a post-surgical appointment. They told me that the doc still has my chart, and therefore they have no instructions. I will try again Monday.
Keep in mind that my surgery was not normal, because I also had a nicked/perforated bladder that needed to heal. Other things to deal with are diet, pain management, and the rubber tube that is draining my urine. We shall take each in turn.
Diet - Kyle, the helpful CNA at St. Marks who had the same procedure, strongly recommended not to eat much for a while. Nurse Vicki recommended stool softeners. Keep in mind that I had no solid food for about 18 hours, except some crackers and some cranapple juice with my Lortabs just before leaving the hospital. I would be taking Lortabs for a while, and these are known for their constipating effects. I was not overly starving, but hungry. We decided to stick with high fiber and carbohydrate foods, low fat and no protein or dairy products at all for a while. The issue is that food (and gas) that move through your large intestine pass behind the bladder, adding pressure to the injured organ. Also any straining to get things out of the bowel would put lots of pressure on the bladder. So I had a few Golden Oreos and whole grain toast with jelly and no butter for dinner, with several glasses of iced tea. Breakfast consisted of oatmeal (no milk) and fruit. Lunch was vegetable soup and more whole grain toast. For the first few days, dinner was the same as lunch. Afternoon snacks were a cut-up apple. By the end of Thursday the GI system had still not shown signs of activity - not good. In addition to the stool softeners I took 4 ounces of Milk of Magnesia (MOM) Thursday night. I called Dr. Chuck, as this is truly his area of expertise. He was disdainful of diet, stool softeners, and MOM, but said to let the MOM work overnight and see. If that didn't work, he suggested the "nuclear option" of Magnesium Citrate solution. Get the one in the green bottle, chill it, chug it, then stand by to evacuate VERY SOON. It would do the job in one fell swoop (plus some aftershocks), and it's what they use to get folks ready for colonoscopy. We got some (no longer sold in a green bottle) and had it available, just in case. Friday morning I did another 2 oz of MOM, and decided to wait a bit before employing the "nuclear option." Friday during the day the gas generator (from all the fruit and fiber) was in high gear, and that night we could both hear (and I could feel) things sliding about the intestines - I discontinued the MOM after that morning and the stool softeners after a week. And when I went to bed I made sure the door to the bathroom was open! No worries though. About 2 minutes after I got up the next morning everything was working again, and over the next 5-6 days things progressed from liquid to normal. And the fiber content of my diet has continued to be high, and will probably need to stay that way. The Magnesium Citrate is in reserve for any future needs, or a really mean practical joke.
Pain Management - Nurse Vicki familiarized me with the hospital's pain management philosophy. They use a scale of 10, where 1 is no pain (with a happy face) and 10 is unbearable pain (with a crying face). She advised me to take the Lortabs when the pain approached 5, and not to try to be a hero about it. Dr. Chuck's wife is a registered pharmacist, and she advised not to let the pain get to any significant level, or it's difficult to use Lortabs to get back ahead of it. I had not experienced any pain at all, and was taking one Lortab every 4 hours the first day. This was probably more than I needed, and went to 5 hours on Thursday evening, and on Friday I decided to shoot for 6 hours, but there was pretty decent pain at 5 and a half. On Saturday I could go a full 8 hours, and Saturday night before bed I took my last one. Had to be very careful moving around on Sunday, and had a full day killer withdrawal headache all day Monday. Tylenol barely made a dent in it, but 3 aspirins taken with dinner seemed to do the trick. Tuesday was near normal. If I had to do it again, I'd let some pain come after the first night to judge when to take the Lortabs, because they effectively shield it, and you tend to move around more than you should the first couple of days. Also, when it does hurt, and then you take the Lortab, you feel TOO good and need to be careful in movement.
Drainage Tube - Moving about with the tube and receptacle felt weird, but wasn't too bad. It really did not add to the pain at all during the day, just some discomfort. Nights were a different story. The only advice I have for everyone is to drink lots of fluids (at least a gallon per day) and pay attention to keep the parts that you see as clean as possible. Details are too graphic for this page, so they are elaborated here: FOR MEN ONLY. Not recommended for women (anatomically incompatible with the graphic descriptions) or the squeamish...
So through the week and weekend we are still standing by for staging and pathology. My guess is the doctor is waiting for the pathology results before he sets up an appointment, which probably means Tuesday at the soonest. He may be waiting to evaluate whether to shoot me with chemo while the tube is in, after which the tube will have to STAY in for a couple more days. After that long some muscle re-training may be required. Might be messy. Oh joy. One thing you can count on is an eating/exercising lifestyle change for me (probably for both of us), given the high probability of prognosis for recovery/survival. There is still a small chance of X months to live. Then it’s chicken fried steak, mashed potatoes, cream gravy, and milkshakes, every day! Of course this is a low probability outcome, so I'm probably just hungry...
Posted by Steve Kelley