Tuesday 25 August 2015

Managing abdominal surgery

The story

We are exceptionally fortunate in the UK to have the NHS. After my in-patient stay last year with cholecystitis, the powers that be decided the time had come to remove my gallbladder with its thickened walls and undisclosed number of gallstones. The optimum time for removal is usually three months, allowing time for the inflammation to die down.

Unfortunately for me, administrative gremlins struck which resulted in my 6-week follow-up appointment not happening until 19 weeks after discharge in late February. Then an appointments clerk rang me the day after my mother died to ask if I was attending a pre-operative assessment in three days’ time when I'd not received any notification, let alone agreed to have a procedure which had not yet been discussed!

The consultation with the new surgeon (someone completely different from the person who had reviewed me in hospital, who I had expected to follow me up) took place in my local hospital the day after my mother’s funeral. Despite being the first appointment, I was still kept waiting for half an hour while he read my notes. The conversation about surgery was very brief. It had to be done. He liked all his patients to go on a diet to shrink their liver and he allowed his patients to drive four days after surgery. We exchanged a few pleasantries and I returned home to await the next communication.

I was somewhat surprised to read his letter to the GP which referred to a “full and frank discussion”. I wondered if I’d been asleep while it occurred.

At the beginning of May, as I was packing the caravan for one of our many weekends away with the kite team, I received a phone call asking if I would like to have my operation in the local private hospital in the next few weeks as they had some free time. We’d just booked a week away with our son and his family so I didn’t want to miss that, so agreed to June 15th. I returned home to find this date had been cancelled because the surgeon didn’t have enough people to operate on. An alternative date would have meant cancelling my writing retreat with a substantial loss of money, so I negotiated to go in a week later.

I was sent the pre-admission details including the week-long 800 calorie diet. I had expected something miraculous if it was going to shrink my liver, instead I was expected to replace two meals with purchased diet products and, if I were lucky, my evening meal could be a protein source plus vegetables from a list which was referred to but not supplied.

I have a moral objection to spending money (which is limited in my household) on processed food so I made out a shopping list for lots of low calorie vegetables, fruit and organ meat. I already had the vitamin tablets to hand and there were vegetables available in the garden.

The real food 800 calorie diet

On waking: Cup of tea with semi skimmed milk

Breakfast: Small glass of orange juice and half a red/pink grapefruit plus a cup of tea with milk

Mid-morning: Cup of herb/fruit tea

Lunch: 2 bowls of soup prepared from homemade chicken stock with a) celery, kale, cabbage, carrot half an onion plus half a red pepper flavoured with holy basil and mint or b) mushrooms, courgettes, an onion, carrot, celery flavoured with herbs.

Or a salad comprised of lettuce, celery, spinach, grated carrot, grated courgette, red pepper, hard-boiled egg dressed with lemon juice plus water to drink

Mid- afternoon: herb/fruit tea

Evening meal: Ratatouille made from 1 tin of tomatoes, 4 courgettes, 1 aubergine, ½ an onion and ½ a red pepper flavoured with holy basil and mint. Served with steam roasted chicken or liver casserole made with aubergine, carrots, cabbage, flavoured with rosemary, or steam roasted chicken served with carrots, broad beans, peas and boiled courgette or stir-fry kidneys with celery, carrot, courgette, onion.

Evening drinks: herb/fruit tea

I wasn’t hungry and I lost seven pounds during the week. When I finally went for my pre-op assessment, my operation had been cancelled again because the theatre floors needed to be re-sealed which meant cancelling the entire weekend operating lists thus causing a knock-on effect further down the week. I didn’t have a revised date because my consultant was too busy doing bariatric surgery to fit me in and a new consultant had to be found. I was not a happy bunny and the nurse carrying out the assessment was worried about me staying on the diet for too long.

Other preparations

Meals for the freezer – this meant Chris didn’t have to do large amounts of cooking during the first week while he was looking after me.

Overnight bag – although I was booked as a day case, I still needed a nightdress, dressing gown, slippers and something to keep me occupied whilst waiting for the operation. I took some knitting and a Cadfael omnibus. The simple dishcloth knitting was wonderful for keeping me calm during the three and a half hour wait.

Herbal medicine – I put together a bottle of combined tinctures with the dosage clearly labelled in an accessible place so Chris would know exactly what to give me and when.

Energetic cleansing of the theatre and support for the operating team – I wasn’t in a fit state to do this myself so left it to those who were providing distant healing support for me, both my healing group and my Druid Grove. This is the chant I have used in the past when undertaking something similar for others.

Before an operation

Come cleansing silver rain

Descend upon this sterile space

Deposing fear and sorrow

Anger and sense of loss

Leaving all fresh and clean

Then light the violet flame

Burning brightly

Burnishing instruments

Rejuvenating equipment

Leaving all in perfect order

For what is to come.

Come now, Raphael,

Bring your hosts

To guard and watch this space

Spread your glittering wings

To comfort all in need

To heal all that is needful

To shine the light of peace and hope within

Call now the healers

Call them close

To watch and guide

To lend assistance to the operating team

That all may be done to the highest good

Of all concerned

Then, in recovery,

Let there be true care and compassion

Let the healers remain

To work on flesh and bone

On blood and organs too

Until all is as it should

As it can be

Let healing light shine forth

To hold each moment

To soothe, to comfort

To surround with love

Let all be done for the highest good

Of body and soul

To aid in life’s rich journey

And beyond

The Operation
We arrived at the hospital at 7am. The new surgeon bounced into my room at 7.30am, announced, "It's going to be horrible in there. If I have to open you up, you'll be here for five days or more." and bounced out again. He seemed to imply the difficulties had been caused by the number of antibiotics given to me during my previous admission but it could have been the length of time (over three years) I had been suffering with the condition.

The operating list started at 8am and I was second on the list. At 11am I was still sitting in my room knitting but luckily the sister/ward manager came in to check I was ok and gave me some more water. Apparently policies have changed and instead of nil by mouth they like you to drink an hour beforehand.

The surgeon did manage to remove eighty per cent of my gallbladder by keyhole surgery. (Chris said he used an old fashioned skeleton key as the major incision was two inches across!) and I came out of the theatre with five holes instead of three including a drain. He had removed three gallstones the size of musket balls. He said it was too dangerous to remove everything as the anterior wall was stuck to other organs. (It was quite sobering to subsequently read his discharge letter to my GP which described the operation as “very difficult”!)

In-patient medication
The anaesthetic cocktail plus liquid morphine and a heavy duty antibiotic (probably Augmentin which necessitated two blood tests the following morning to check liver and kidney function). After the morphine wore off I was given paracetamol and then codeine phosphate at four hourly intervals.

Post-operative issues
Pain – from coughing, movement and internal muscle spasms plus bruising from the anaesthetic venflon in the back of my hand.
Throat – the anaesthetist warned of a sore throat but didn’t mention the post-nasal drip, thick mucus which had to be removed by coughing and “semi-detached” skin flakes on the back of my tongue, plus dehydrated lung tissue arising from the anaesthetic.
Nausea – presumably a reaction to either the anaesthetic, morphine or both. I refused any anti-emetics because they made me feel “spaced out” for several hours when I was given them before.
Internal muscle and other tissue damage from the surgery
The abdominal drain- which prevented me sleeping in any position other than flat on my back and meant I must be aware of the position of the drain bag at all times.
Liver support – necessary because the liver processes all the toxins/medications pumped into me
Bowel regulation – both morphine and codeine derivatives cause acute constipation. Straining to pass “movements” can cause piles and damage newly healed internal organs, so is not advised. I was discharged with senacot tablets but didn’t take any. I had been warned before the operation about possible effects of “bile dumping” by herbalists if I ate fats but this wasn’t mentioned by the surgeon. Only the nurse who cared for me post- surgery and prior to discharge, whose wife had had the same operation, told me I might experience something similar to diarrhoea the day after eating fats.
De-hydration – caused by pre-op nil by mouth, only small amounts of water and two bouts of vomiting over a 36 hour period.

Issue Management Strategies
Although leaving hospital is scary, being in your own, quiet and comfortable home does improve the healing process. The regime of tinctures I’d blended included

Dandelion and burdock for liver support
Plantain – for tissue regeneration, healing dry membranes in lungs and anti-inflammatory
Yarrow – anti-inflammatory and bruising

To this I added
Crampbark - to deal with the internal muscle spasms I’d not anticipated
Fire cider vinegar and honey – I only needed one drink of this to sort out the mucous on the second day when it was becoming intolerable. If I’d thought about it beforehand, I might have made up a respiratory cider vinegar with rosemary, sage and marshmallow but I probably needed the garlic, chillies and other spices as it worked so quickly.
Natural yoghurt and homemade raspberry puree – taken soon after returning home to coat my stomach lining following the bouts of nausea and provide some sustenance after my fast. I had three small amounts at hourly intervals and was then able to face other small meals with no ill effects.

Pain control and bowel regulation - The first few days were not fun; you never realise how many things involve your abdominal muscles until they’ve been damaged! I was also determined to use the minimum of pain killers so I wouldn't have to use a laxative. I managed on three doses of soluble aspirin throughout the day for three days then Chris said those ought to stop, so from day 4 I had one last dose in the morning before travelling to the acute hospital to have the 9" of drain pulled out of my stomach and didn't take any more. It was amazing how much better I felt after this procedure. After half an hour’s rest I was able to walk outside into the garden and stand and pick my St John’s Wort flowers for the next hour!
The first bowel movements on day three were difficult but eased by day four. I tried to drink as much as possible and was eating lots of fruit and vegetables including fats.

Every day I improved. For a whole week I did nothing but rest with the minimum of movement. On the Sunday evening I began to feel a little like myself. I was able to teach a few piano pupils in week 2 and a herb workshop at the farm on the Thursday. I had another workshop at the end of the third week, then we went off to Cornwall for two weeks to meet up with friends. I found I was able to drive and go for walks. I still get tired but I'm able to do most things. I have to remember not to carry anything heavy until three months are up at the end of October.

I am now able to eat anything, which isn't a very good thing as I've put back most of the weight I lost prior to the operation and I'd like the scales to go down instead of up! Still, there won't be any more scones, cream and jam for another year! I'm not in any pain apart from the gall bladder area still feeling raw sometimes. My bowels are working well and have had limited problems, for which I am extremely grateful.

I'm sure my quick recovery has a lot to do with the herbs I’ve taken and all the healing energy I've been sent from many different sources. Back in the 1980s, research was carried out which confirmed that people undergoing surgery who were prayed for recovered more quickly than those who weren’t, whether or not the patient knew about the prayers. I’m very grateful to everyone who has taken time to send positive thoughts in my direction.

Although this is a very personal story of abdominal surgery, I hope others will be able to take something away to help with their own circumstances.