Week 5…The Doctor Did Not Warn Me About THIS

This past week has been one of the worst since the surgery.  The stent removal itself wasn’t bad. Or maybe it was, but I don’t remember because I was knocked out cold. But the after effects and the trauma to the ureter were pretty rough.  Between the discomfort, pain and at times, downright depression, I’ve not felt like writing anything. I started 3 separate posts but could only complete 1.  No motivation and total lack of concentration. Multiple posts on how much things sucked did not appeal to me.  So, I give you a basic rundown of how last week progressed.  

Monday:  Drive to surgery center at 5:30am. Prep at 6:00. Procedure at 7:00. Did not like the “gas mask.” Felt like there was not nearly enough oxygen flowing. Felt like I’d suffocate. But I was out by the third deep inhalation. I was awake and chatting up the nurses before 7:45.  I do not remember a whole lot about that. I do remember they were shocked at how fast I came out of it.  I remember the surgical nurse has a wife who is a social worker at the VA. NO CLUE how we got on that topic. I’m sure I initiated it, though.  I remember another nurse asking me about pain and I guess I said I was hurting because she gave me two Percocet.   I remember being hungry. I remember the nurse saying it would be best to stick to clear liquids for a few hours. I remember ignoring that advice. And I distinctly remember REGETING that I ignored it.  Honestly, not a whole lot more I even remember from the rest of that day.

Tuesday:  I spent the day in a fair amount of discomfort.  The trauma from having the stent REMOVED was far more intense than I anticipated. I was popping the pills every 4 hours trying to stay ahead of the pain.  Made it tolerable but did not erase the pain. It did allowed us to get out of the house for a short time and go check out Hometown Comic’s (our local comic book shop) new location, buy a new card game (Snake Oil) and then go grab a bite at Applebees.  I was moving very slowly and gingerly the whole time we were out. And by the time we got back home, I was ready for a nap.

Wednesday:  Exhausted. Extremely high anxiety day. Cried on and off. Took anti-anxiety meds...which I rarely do. Slept a LOT throughout the day after that.  Pain was minimal, which was good. Managed a blog post. But that was it.

Thursday:  Felt GREAT. Walked a mile and half in under 27 minutes.  No pain, no discomfort.  Excited because things were improving.  We drove up to get The Boy from school. Sure, he’s only been gone a week, but it was really nice to see him for a bit.

Friday: I twisted the wrong way, aggravated the still healing ureter and spent the rest of the day in as much pain as I had been in on Tuesday.  We had to drive down to Cincinnati and by the time we came home, I was in more pain than I’d been in since right after the surgery.   Again, I was taking a half to a full pain pill every 4 hours.  By 1:00am I was online looking up info to see if this was normal or if I should be calling my doctor’s answering service to see if I should head to the ER.  My urologist said NOTHING about having serious pain after the procedure. Just some “discomfort.”  Sure enough, a lot of people have gone through the same thing.  Found out I should have been taking NSAIDs…NOT Rx pain relievers.   Popped a couple of Ibuprofen and I was feeling SO much better within the hour.  (BTW, this was NOT caused by the walking from the previous day)

Saturday:  basically involved me taking Ibuprofen and resting and doing a bit of crying.

Sunday: Much better.  Spent time folding clothes and doing light housework. And doing a bit of pouting because the husband has been cleared for travel after spending nearly 3 months at home.  It’s been nice to have him around every day, but it’s also nice to know that his company is anxious to have him back on site. As much as we hate the travel, we do not take for granted how blessed we are that he has a good job.

Which brings us to this morning:  Feeling SO much better. Dishes done, laundry started. Feeling positive again.  Waiting for the daughter to come home and take me to the trail for another walk.  But, the house feels too quiet. I cherish the quiet. I really do. But I think it will take me a while to get used to it again.  

Falcon Punch to the Kidney!!!

*From Saturday August 17. I had started writing this and before I finished decided a nap was a better idea. Thought I should post this BEFORE the removal rundown.

Good grief! This stent cannot come out soon enough!  I am always aware of its presence.  Some days are more tolerable than others.  This morning while I was emptying my bladder I felt like I’d been punched in the kidney. As the bladder contracts, it moves the stent, which irritates the ureter AND the kidney. This was a sharp enough pain that I actually let out a yelp.     

Drawing from http://www.fairview.org/HealthLibrary/Article/83047
(In my case the blockage comes from the sutures, not a kidney stone)

I find sitting up straight for too long really aggravates things.  Not a sharp pain, just a dull, constant ache that gets stronger with time.  I guess that makes sense. When I am in a more reclined position, the stent is basically straight.  When I sit up, the stent has to bend a bit. Although it is very flexible, it is still putting pressure on the ureter, kidney and bladder, a pressure that they are not meant to deal with. 

(I hate the dangling preposition. But for me to type “..a problem with which they are not meant to deal”  just sounds so…elitist, arrogant, British??? *sigh* How to use proper grammar without sounding like a snob?  Is there a book by this title?)  

It also seems that this is becoming more uncomfortable as the days pass. I am not sure if the stent is moving further down into the bladder, causing more pressure on the kidney or if my body is just tired of this and no longer tolerating it.  Regardless, I have had to take more pain pills the past few days than I have in a while. And all due to this damn thing.  I honestly believe if it weren’t for the stent, I would be completely off pain meds and only using Ibuprofen. 

On the other hand, I am VERY aware that I am lucky to have the evil thing.  I could be dealing with far worse issues if my doctor had not noticed that he nicked me. I am grateful it was taken care of the DAY of surgery and NOT weeks down the road. 

Have I mentioned how much I love my doctor?  YES...he is the one who nicked me. But considering the fact that everything was basically super glued together down there, I think he did a damn fine job! And I credit his 30+ years of experience to my relatively easy recovery.  

Just two more days.

Follow up and pre-op: Bull Shit and Plumbing

 Living in a smaller town has me a bit spoiled in regards to many things.  Rarely do I have to wait more than a few minutes to get a table on a Friday night, lines at the theater typically are not that long (unless it is opening night for a big release…which is something I avoid at all costs, so I’m safe), and when seeing any of my doctors here in town, I am back in the exam room fairly quickly.  Going into Indy to see a specialist is quite a different experience. 

I made sure to be at the urologist office 15 minutes BEFORE my appointment, to assure the women at the front desk had time to copy my insurance card and gather my paperwork.  I was very pleased that I was there early, like they requested in the pre-appointment letter.  On the other hand, I could have arrived 30 minutes late and still made it in plenty of time for my appointment.  We ended up sitting in that waiting room for over an hour.   

On the plus side, we did get to spend that time being entertained by a very animated, 62 year old man who talked about growing corn and the proper way to cook it, raising children, dealing with “street hustlers” and the lack of accountability of his no good druggie brother.  “We was raised by the same mother. There ain’t NO need for him to be doing drugs that way. And it ain’t my job to be taking care of him. I tried that once. Ain’t doing it no more.”   

He was there due to surgical complications of which were bad enough that he was on disability and now basically retired. We are pretty sure that he misses work and REALLY misses being able to talk to people. He was a bit of a character and I really enjoyed interacting with him.  “My mama used to say “All that is is chewed up grass and water.” Ya know what that is?  That is bull shit. That’s what my mama would say.”   Everybody has a story. 

I FINALLY got back to see the doctor.  He said I need  another 2 weeks and then we will test to see if everything has healed. They want to make sure no scar tissue is growing and potentially blocking off the ureter. This could lead to all sorts of complications, including the loss of a kidney…which I suspect would royally suck.  So next Monday (my appointment was last week) I go into the surgery center, go to sleep, have stent removed, contrast injected, piping tested and HOPEFULLY, receive an all clear. Otherwise, another stent is put in and we do the whole thing over a few weeks later.   He also gave me a sample Rx for Flowmax, which is supposed to help me empty my bladder if needed.  Really hoping I won't.

Honestly, as annoyed as I was that I had to wait over an hour for a 5 minute consult with the doctor, I think it was worth it just to listen to the narrative of my waiting room companion.  THIS is the stuff I live for.  

Post Op: Three weeks down and some irritations.

For the most part, I am healing much faster than anticipated. I feel I have been very lucky.  But there have been a few issues I could certainly do without.

My stent is still bothersome.  Much of the time I feel I have a mild urinary tract infection and lower back ache.  My husband said he went through the same thing when he had his stent in last spring. (It’s nice to have those special moments of bonding, right?)  I have an appointment with the urologist tomorrow. It will be an office visit to discuss the stent removal procedure and make the appointment for that visit.  The removal will involve going back to the surgical center and being put under general anesthesia.  They will take out the offending medical device and inject some sort of contrast to make sure the sutures are healed and there is no leakage from the ureter into my abdominal cavity.  If it is not healed properly, another stent gets put in.  I do not know if it will involve any sort of laparoscopic incisions to re-suture or not. Will find out for sure on Wednesday.  Understandably, I am a little bit nervous.  I will be so glad when this is done.

Incision site is feeling odd.  Finally took the steri-strips off.  Noticed the site was weeping a bit. And I have a “pulling” sensation at the area since taking the strips off. I called the nurse and she said as long as the weeping does not have blood or pus, is not excessive, and the site is not hot to the touch then all is normal.  There is a bit of stinging at the site. But that is about it. 

Another issue I’ve dealt with is a yeast infection.  On the last evening of taking my antibiotics I developed one, despite the fact that I was eating yogurt on a daily basis to avoid it. (This pissed me off a great deal. It looked like I was going to get through a large course of antibiotics and NOT get a YI) The symptoms seemingly went away for a couple days, then came back.  This happened two more times and each time the discomfort would start at night, while the doctor’s office was closed, then not be present in the morning. When I called the nurse regarding my incision I thought maybe I should ask about the yeast issue.  She sent an Rx to my CVS, a lovely single dose tablet. Fluconazole 150mg.  No messy creams or suppositories. Everything cleared up VERY quickly.

Last night I dealt with some night sweats.  Primarily involving my lower body. A bit clammy up top, but sweat was running down my legs.  Yes, for a split second I was worried I’d had some sort of accident.  Not the case. Just sweating like crazy.   I have had previous night sweats since the surgery, but this was the worst.  Woke up 3 times from it.  Still, I cannot complain too much. The bHRT pellets really seem to be working.  Few night sweats, no real hot flashes to speak of and my emotions have been pretty leveled out.  Crying a bit more the last few days, but nothing more than what I had been doing BEFORE surgery.  And no RAGE issues! I think the kids are feeling they can slowly come out of hiding now. 

Walking is not coming along as quickly as I’d like. Spent the first 12 days only walking around the house.  Then on July 29^th  I finally went to the trail and waddled  ½ mile in 23:41 minutes. It was so slow, but movement was really good. On August 3^rd I walked 1.08 miles in 20:04. I was amazed at how “fast” I was going. My body did not protest. Legs and abdominal area felt fine.  Then I tried walking again yesterday, Aug 5^th, hoping for another mile. I was only able to go for .55 and that took me 16:34.  It was rough. Incredibly tired, stinging around the incision. I was glad to get back to the car. Really disappointed with how much it took out of me.  No walking today. In fact, I took two long naps and have barely left the bed. 

I realize that I should not beat myself up. Recovery is not a linear process.  I will have good days and bad days.  Good hours and bad hours.  I cannot be impatient with the healing.  I cannot risk setting myself back by pushing myself too hard.  I am NOT a failure because I can’t walk 3 miles 3 weeks after surgery. Full recovery will happen in time.

"I Don't Believe in the No-Win Scenario."

Post op mile stone:

Last night, for the first time since surgery, I slept through the night.  I was asleep before midnight. And I woke up only because some inconsiderate jerk left the bathroom light on and it was shining in my eyes!  

Of course I felt a little foolish when I realized that, noooo, I was facing away from the bathroom and I was in fact turned toward the window.  

The SUN was shining in my face!  I had slept through until the sun was high enough to shine IN MY FACE!  That just does NOT happen. EVER!  Even pre-surgery!

Granted, I DID have the help of a full pain pill last night.  Took half at 9:00pm and the second half at 11:00pm. That is the most I have had in days. So it pretty well knocked me out. But I will take it. I know my body needs that sleep. 

********

Two steps forward…maybe (NOT) 2 steps back:

There is a chance I will experience a setback. And I won’t lie, I am a bit nervous. If I let myself dwell, I get scared.  I believe I am having issues from the nicked ureter and stent.  This has me worried.  Of course after realizing it was probably stent issues, I decided to look up information on the topic and discovered this:

http://emedicine.medscape.com/article/454617-overview

Authors: Sandip P Vasavada, MD, Raymond Rackley, MD, Jeffrey B Garris, MD, Francisco Talavera, PharmD, PhD, Michel E Rivlin, MD, J Stuart Wolf Jr, MD, FACS , Bradley Fields Schwartz, DO, FACS  

“Ureteral injury is one of the most serious complications of gynecologic surgery. Less common than injuries to the bladder or rectum, ureteral injuries are far more serious and troublesome and are often associated with significant morbidity, the formation of ureterovaginal fistulas, and the potential loss of kidney function, especially when recognized postoperatively. For these reasons, injuries to the urinary tract, particularly the ureter, are the most common cause for legal action against gynecologic surgeons.

Despite the close anatomical association between the female reproductive organs and the ureter, injury to the ureter is relatively uncommon. Nevertheless, when a ureteral injury does occur, quick recognition of the problem and a working knowledge of its location and treatment are essential in providing patients with optimal medical care.”

This last little bit “quick recognition of the problem and a working knowledge of its location and treatment are essential in providing patients with optimal medical care” DOES make me very hopeful.  They knew RIGHT away when it happened and called the urologist in to stitch and stent me up.

The most serious cases come when they do not realize the ureter was damaged to begin with and the woman goes home…only to come back to the ER days later, septic and on the verge of losing a kidney.  This obviously is NOT my case. 

Right now my main concern is will I have to have a stent long term? (meaning months or years?) The stent is fairly uncomfortable and the ½ pain pill I take seems to be the only thing that really dulls that. To put it in perspective, it is nearly as uncomfortable as my bad cramping from the endo. Not a sharp pain. But constant, strong, dull pain/pressure.

 IF I do have to do this long term, will it affect getting back to running? I have plans to PR my 5K and 10K times in 2014.  Will it cause sex to be painful?  Will the constant discomfort of the stent cause my drive to go down?? I have plans to PR in that area, too! (I know, I know. At this point, I should not be concerned with this. I am not even supposed to think about sex for another four and half weeks.) My constant discomfort from the endo caused me to suffer academically last semester. I am VERY concerned about that. I have been looking forward to going back to school in January and kicking some GPA ass.  So the thought of THIS interfering with school is really starting to piss me off. 

I firmly believe that knowledge is power. So, I can’t just “let it go” and “not worry about it” until I see the doctor. But I also know, one can get carried away when reading “horror” stories about worst case scenarios.  I want to learn all I can about this and what *I* can do as the patient to turn this into a BEST case scenario. And not give myself nightmares thinking about all the “what ifs.” 

I discovered this site a bit ago and am finding it very helpful in explaining how things work, what I should look for, and what to expect while having the stent. 

http://www.bui.ac.uk/PatientInfo/ureterstent.html#1

I am trying to stay hopeful that after everything heals, this will be the end of it and no more issues will come up.  And trying to stay OUT of the mindset that I might have just traded one problem in for a different one. 

So, I leave you with this:  

 “I don’t believe in the no-win scenario.”

http://www.youtube.com/watch?v=8N-H1lz3OJ4