Posted 5/12/2013 12:19 AM (GMT -7)
There are a lot of horror stories and anxiety floating around this forum, so I thought I would share my own experience which has been very positive. I did not, am not, and will not be keeping a day-by-day diary but can at least give an overall idea of what the surgery and recovery has been like.
Quick background: I am 29 years old. I have had reflux and regurgitation issues for about 4 years now. It started after I had my gallbladder removed and it was found out during my pH probe study that I actually have bile reflux rather than acid reflux. The result is basically the same, burning sensation, pain in the chest/throat, etc. I also had a 4cm hiatal hernia. I also have gastroparesis and worse than normal motility in my esophagus, which both contributed to why my surgeon decided to do a toupet instead of a full nissen (basically he did not wrap the fundus all the way around my esophagus as he would have with a full nissen.)
As far as prep for the surgery itself went, I did not have to be on any kind of special diet prior to the day of the surgery. I did not have to take any laxatives, give myself an enema, or any other kind of bowel prep at all (before, during, or after the surgery.) The only instructions were no food or drink after midnight the night before the surgery.
So, the day of the surgery, my husband and I got to the hospital 2 hours early, as instructed. Got registered, got my armband, got taken back to pre-op. The nurse took my full medical history, then went over the specifics of the procedure (most of which I knew already from talking to my surgeon.) They were doing the toupet (partial nissen) and a hiatal hernia repair, robotically/laproscopically. He had me read over the complications disclaimer and sign the consent form. He filled out an allergy armband for me (since I have several food allergies) then had me get into the gown. After that, time for the IV, which I was very paranoid about due to a badly botched IV attempt several years ago at an ER by an incompetent medical assistant.
First he took his time picking the right spot to put it, which turned out to be in the middle of my left forearm. I didn't even know they could put an IV there. He said it would be better there than in my hand since it would be more out of the way. He gave me a tiny shot of lidocaine, which burned badly for about 2 seconds, then went numb. I was squeezing my husband's hand with my other hand like crazy when the nurse started putting the IV in. Before we knew it, it was over. I didn't feel a thing since the lidocaine numbed everything. They got me started on a saline drip but nothing else at that point.
The OR was backed up by a couple hours, so they put us in a private room and turned on TV and we waited. A few friends stopped by who were allowed to come back to see us and help pass the time. about 4 hours after we had gotten to the hospital, the anesthesiologist came in to introduce himself to us and told us they were getting the OR prepped for me and it was almost time. He left and a few minutes later, the OR nurse came in and finished getting me prepped. Cap on my head and an injection of something to relax me. It didn't knock me out, so I gave my husband a kiss, waved goodbye to him and our friends, and the nurse wheeled me out and toward the OR.
I remember getting into the OR and the anesthesiologist telling me he'd be there the whole time and to just relax. I also remember a tech or another nurse was there to help me onto the actual operating table, but after that it's a blank.
I woke up in recovery and it hurt to breath (this was also true for my gallbladder surgery so it wasn't entirely unexpected.) The nurse in recovery told me the surgery was over, it had gone very well and the surgeon was very pleased. One of the very first things I remember after waking up was burping. They were tiny burps, not belches, but there were several of them. My throat did not hurt at all (they warned me it might since they had to intubate me during the surgery, which was done entirely while I was out so I have no memory of it.) My stomach, where the incisions are, ached, as did my left shoulder (referred pain from the work done on my diaphragm to repair the hernia.) The aches were not unbearable. The worse was trying to breath deeply, which they needed me to do to keep my oxygen levels up. A machine would beep every time my oxygen dipped below a certain point. I kept dozing off and waking up to the machine beeping. I got 2 doses of morphine and several warmed blankets, since I was freezing.
I had been cathetered during the surgery but it was put in and removed while I was out, so I had no memory of it and it did not hurt when I woke up. I also had some kind of gel in and around my eyes, which the nurse told me they had used in the OR to keep my eyes from tearing up during the surgery. It did not hurt and I didn't notice it at all except that my vision was a little blurry (which could also have been because I was missing my glasses and because I was slipping in and out of consciousness at first.)
I stayed in recovery for a long time, longer than I needed to, but they were looking for a room to put me in. Eventually they gave me ice chips and I started waking up more. Finally they had a room ready for me, probably 2-3 hours after I had initially woken up. The nurse wheeled me out of recovery and into a huge elevator and we went upstairs and into my room. Her and an aid were able to slip a plastic mat underneath me and then pull me onto my bed from the gurney, so I didn't have to move at all. My husband and a friend were allowed in to see me (they were not allowed in to recovery so this was the first I had seen them.)
I was brought a tray of dinner and told to eat if I felt like it and wasn't nauseous. Since I was on a liquid diet (full liquids), dinner consisted of jello, iced tea, applesauce, juice, and tomato soup. There was also a patient snack area right across the hall from my room that had more applesauce, jello, and juice as well as popcicles and ice cream that I was allowed to have. I had my husband grab me a popcicle since I wanted something cold and nibbled on it a bit but it took me about an hour to finish. It went down without any problems.
I kept wanting to nod off but was in a good deal of pain at this point so we called for a nurse. Unfortunately, it was change of shift so we didn't see anyone for over an hour. When the nurse finally came in, I also had to use the bathroom. She had me try the bedside commode first since I had not been up since the surgery. I tried, but it was...small. So I slowly made my way to the actual bathroom, holding onto the wall to steady myself. I was actually feeling quite clear-headed at this point and did not have any trouble getting to the bathroom or going #1. The nurse was very pleased. She gave me a hydrocodone tablet for pain. It was big and did not go down easily so after that I learned to break them in half. After it was down, I fell asleep for about an hour.
When I woke up, I felt great. I was a bit hungry so I had some of the tomato soup, some of the iced tea, and a couple bites of jello. Everything went down fine. I was feeling strong, clear-headed, and not in too much pain, so my husband and I went for a walk around the nurse's station. This was about 5 hours post-op and I made 2 laps around the nurse's station and then was able to go to the bathroom again. After that, I was wiped and it was pretty late, so I sent my husband home to care for the cats (they had offered to let him spend the night on a little pull-out couch bed in my room, but I wanted him to get some decent sleep), dimmed the lights in my room, and settled down to sleep.
Unfortunately, between the nurse coming in to take my vitals and me waking up from either pain or having to go to the bathroom, I did not get much sleep. On the bright side, my blood pressure was coming down nicely. It had been rather high, around 160/100, immediately after the surgery when I woke up, but got down to about 135/80 that night. They took me off the IV, which was just a saline drip at this point, since I was tolerating food well (and it made me go to the bathroom every hour.) I got about 2 1/2 hours solid sleep from 3:30am to 6am and then took another walk around the nurse's station. I was stronger still and able to go longer and further.
Things were busy in the morning. Change of shift was at 7am so the night nurse came in with the day nurse and introduced us and went over my medical history and last pain medication. Someone from the kitchen brought me breakfast (very similar to dinner the previous night, except with cream of wheat instead of tomato soup.) Someone else came in to tidy up the room and clean the bathroom. And an aid came in to take my vitals (BP down to 125/75. She was pleased.) I slept in about 30-45 minute increments between each of these visits since I was very tired.
Sometime that morning, I had my first bowel movement since the surgery, which the nurse was thrilled about. She said I would likely be able to go home later today since I was eating, walking, and now passing gas/stool. I tried to have another jell-o cup for breakfast but was feeling nauseous. It did not pass on its own so several hours later, I asked for some anti-nausea medication. It worked well but unfortunately also made me very sleepy, just when my husband and some more friends came to visit me that morning. I dozed while they were there and eventually, in the early afternoon, my surgeon came to see me. I was feeling very good aside from being exhausted. He asked me a bunch of questions and was pleased with all my answers and said I could go home. We had to wait about 2 hours still for the nurse to write up the discharge papers, as she was very busy. During this time, I was brought lunch -- more jello, iced tea, juice, yogurt, and tomato soup. I ate all of the soup, some of the tea, and an ice cream cup from the patient snack area. All went down well and did not cause any upset stomach issues thanks to the nausea medication I was given.
I should note that during my stay, I was given pain medication basically as needed. We alternated between hydrocodone tablets (which, as I said, I broke in half to take and they went down okay) and morphine shots thru my IV line (they took me off the saline drip but left the line in until right before I was discharged.) I was taking some form of pain medication every 4-6 hours on average for the first 24 hours after surgery. Most of my pain was in my left shoulder and still some in my chest/lungs when I breathed. By the time the surgeon came to see me (which was about 22 hours post-op) I had no pain in my incisions.
After the nurse got the discharge papers written up, she took the IV line out (didn't hurt a bit although it was, and still is 16 days post-op, bruised) and I was able to get dressed. My husband went down to pull the car around to the front while one of the receptionists got me a wheelchair and wheeled me downstairs. We got the car loaded up (I had brought books and portable game systems, expecting a 2-3 night stay) and off we went.
We made a quick stop at the pharmacy to drop off my scripts -- one for pain (more hydrocodone) and one for nausea -- and I walked around for a bit, enjoying being out of the hospital. Then home to sleep! It was amazing to be back in my own bed, even though I'd only been gone 1 night. The cats were very happy to see me but my husband shooed them out of the bedroom and tucked me in so I could rest. I was surprised and pleased when I was able to lay on both of my sides with no pain. By about day 3 I was able to lay on my stomach, a common sleeping position for me.
I was told to stay on a full liquid diet for the first 2 weeks but was also told that if I felt up to trying soft foods, I could, slowly and carefully, and that I wouldn't damage the wrap even if something got stuck. Here is a list of things I ate during the first 2 weeks:
Ensure (including chocolate, which some online diets say to exclude but don't say why)
Apple, grape, cranberry, and vegetable juice
Yogurt (including frozen)
Chicken & Beef broth
Instant mashed potatoes thinned with milk or broth
Pureed butternut squash thinned with broth
Tomato soup (try throwing some in a blender with a few crackers to give the soup a bit more body/taste)
During week 2, I also tried the following:
Macaroni & Cheese
Chex Cereal softened in milk until mushy
Most things went down very well. I had a few minor instances of sticking but none that lasted more than a minute or two. With lots of water or other liquid they got down pretty quickly and easily. I have learned I need to eat slowly and small amounts at a time -- easier said than done once I started getting my appetite back (after about the first week.) Small bites and spreading a meal out over about 20-30 minutes really helps everything to pass the wrap easily.
I have had a few more sticking problems the last couple of days as I have tried introducing more soft-solid foods. One last night with a bite of cheese ravioli and one today with a bit of vegetable curry. I got nauseous for a minute or two while the food was stuck, but as with other things, I was able to get it down by drinking multiple small sips of water. I have been feeling very good and maybe pushing myself a little too hard the last couple days. I think tomorrow may be a liquid day just to give everything a rest.
Overall, my recovery has been remarkable. It has been much, much easier than my gallbladder recovery (which was also done laproscopically but had my laid out flat on my back for almost 2 weeks and another 4 on top of that before I could really function well.) I have been up and about since day 1 post-op with little to no pain. The only pain I really had to speak of was in my shoulder. It was mostly a dull ache except for a couple of days about a week after the surgery, when it spiked and was a sharp, throbbing pain for hours at a time. The hydrocodone did not help much, it mostly made me woozy and gave me weird dreams. All in all I think I took maybe 6 of the 24 tablets they gave me. I was also allowed tylenol and/or ibuprofen (my painkiller of choice) which did about as much as the hydrocodone but didn't make me feel like I had a hangover.
I am able to have bowel movements but they have mostly been very lose and/or diarrhea. But, I have them frequently and they are not painful. Probably the strangest thing of all was that I got my period about 4 days post-op. I take a birth control pill that prevents me from getting periods (it's called Amethyst, the generic of Lybrel, and I take it because I get horrible migraines during my menstrual cycle, and this has greatly reduced the number of migraines I get.) So it was very strange when I got my period. It lasted about 5 days and was completely normal aside from the fact that I don't normally menstruate. My surgeon's nurse thought it was just from the stress/trauma the body has been through.
My incisions were sealed shut with some kind of surgical glue that they said would come off on its own. Well, for one of the incisions, the glue came off in the shower a few days ago, and took most of the scab covering the incision with it. It has been bleeding slightly ever since. I cleaned it well with antibacterial soap, then with hydrogen peroxide, and have been keeping a large band-aid over it, which I change every day. I also have been putting an antibacterial salve (a neosporin generic) on it with the band-aid. It is still bleeding slowly but not enough to bleed through the band-aid and the nurse said as long as it's not red, hot to the touch, oozing anything besides blood (like pus), and I don't have a fever, it should be fine. All of my incisions itched a lot during week 2 and it was kind of difficult not to poke at them.
My surgeon took me off omeprazole (previously was taking 40mg 1/day) the day of the surgery and I have had no reflux or regurgitation since then. I have had a couple minor instance of "heartburn" which I think has just been the esophagus healing and/or a piece of food being kind of stuck near the wrap. I has not kept or woken me up at night.
I was sent home with an inspired spirometer, a plastic cylindrical device that I used to breath and strengthen my lungs. I used it for about the first week, during which time it made me cough and I coughed up old dark blood (they said that is normal thanks to being intubated during the surgery.) I also had a lot of dark blood when I blew my nose. After about the first 5 days of using the spirometer I was not coughing anymore and could tell my lungs were about back to normal.
So, what else? I think that about covers everything. Overall, my experience has been very excellent and I would do it again in a heartbeat. My recovery has not been too bad and at day 16 I am slowly trying to re-incorporate soft-solid foods into my diet. I have lost about 10lbs so far (not bad since I was/am overweight.)
I apologize for the length of this post but hope that someone is able to find it useful. I had a lot of anxieties about the surgery itself and the hospital stay (I had never stayed overnight in a hospital prior to this) which is why I detailed both so well in this post.