2015 in review

Here’s MY year in review … just in case you’re interested. ūüôā

Here’s an excerpt:

Madison Square Garden can seat 20,000 people for a concert. This blog was viewed about 68,000 times in 2015. If it were a concert at Madison Square Garden, it would take about 3 sold-out performances for that many people to see it.

Click here to see the complete report.

Hysterectomy … usually an elective surgery

Elective surgery, emergency surgery, cosmetic surgery, necessary surgery … WHAT are the differences?!

All those surgery categorizations get confusing.¬† And just who thinks a hysterectomy is elective? While many won’t see general hysterectomy in a non-life threatening situation as an emergency, the word elective becomes confused with unnecessary. ¬†And, I’m pretty sure we can conclude that about 99% of hysterectomies are not cosmetic … although, I do feel more beautiful after having mine! More like inner beauty — not outer. ¬†(Although, Australia, whereupon I last check, considers¬†da Vinci¬†hysterectomy as a cosmetic procedure!)

Elective surgery or elective procedure (from the Latin eligere, meaning to choose) is surgery that is scheduled in advance because it does not involve a medical emergency.

EMERGENCY HYSTERECTOMY ¬†1cf2e487d7982e4561ed41447c637772 is when the uterus has ruptured caused by some sort of trauma, being childbirth, a bad physical trauma like a motor vehicle collision or perhaps a surgical misadventure (yes, that’s a real term) when the scalpel or whatever instrument a surgeon may be using, has irrevocably damaged the uterus … and the end result is that the uterus must be removed to save the woman’s life. ¬†THIS is an emergency.¬†

Surgical and/or medical misadventure: 

Misadventure: an adverse event that occurs during medical or surgical care and is caused by that treatment.  Example: intra-operative accidental laceration.

I know personally, when I was grabbing my middle, crying and hoping to die related to the pain of my horrible satanic cfed1540e5716997bb562df92c4f9180SEVERE dysmenorrhea I¬†felt like I needed an emergency hysterectomy … but feelings and necessity are two very different things.

ELECTIVE HYSTERECTOMY is the usual or most common category of hysterectomy performed. ¬†Elective hysterectomy includes those done for chronic pelvic pain or severe dysmenorrhea (my reason), severe endometriosis, uterine fibroids with or without bleeding, uterine cancer — and yes, I did say the C word* (more on that later), severe anemia from menorrhagia ¬†(chronic blood loss anemia from the uterus), uterine prolapse and/or failure to obtain relief or function from unsuccessful non-hysterectomy procedures, treatments or medications.

*Back to that C word ... yes, you would think having a hysterectomy for cancer (there are many different types of cancer) is an emergency.  And yes, having a hysterectomy due to cancer will probably save, if not lengthen the life-span of any woman having this surgery.  However, elective means choosing in advance.  Emergency means imminent and usually life-saving or at least making the best attempt to save a life in a STAT (short turn around time) situation.  screen-shot-2014-01-10-at-2-48-08-am

Cancer can be treated medically through chemotherapy, holistically through non-traditional medical modes and/or by radiation … usually treatment is some combination of all of these combined with surgery.

A hysterectomy for invasive uterine cancer is likely to be more urgent than one done for severe dysmenorrhea! ¬†But both are performed electively. ¬†In addition, the woman with cancer may experience no obvious symptoms, while the woman suffering chronic pelvic pain can detail pain and other negative symptoms affecting her quality of life. ¬†A woman can elect no treatment, no medication or elect everything¬†and anything be done¬†… but she is electing — she¬†has the¬†opportunity to make choices in advance of a split second.¬† ¬†No one else is making that choice in a STAT situation to save her life.

And yes, I highly recommend if any woman has uterine cancer that she get a hysterectomy with of course, consultation with her physician(s). ¬†I also recommend getting the hysterectomy sooner than later in the vast majority of uterine cancer diagnoses, but again, I’m not a doctor. ¬†I’m only operating on what seems to be usual practice, common sense and observation of treatment as recommended when a uterine cancer diagnosis is made. Uterine cancer is not something that will go away on its own left completely untreated.

Here are some other ELECTIVE SURGERIES … in no particular order:

  • cataract surgery
  • cholecystectomy (gallbladder removal)
  • vasectomy
  • carotid endarterectomy (opening up partial or complete blockage of carotid arteries)
  • mastectomy for breast cancer
  • carpal tunnel surgery
  • total joint replacement of the knee (hip, shoulder, etc.)
  • inguinal, ventral or umbilical hernia repair (provided there is no emergent bowel constriction)
  • melanoma excision
  • cerebral aneurysm clipping
  • CABG (coronary artery bypass surgery)
  • gangrenous toe amputation/s
  • etc.

Some of the above surgeries can definitely be emergencies under the right (or wrong) circumstances! While most of these surgeries appear as though they should be performed immediately, there are people who choose not to have these surgeries for whatever personal and/or recommended reasons by managing them medically with alternative ways.

ELECTIVE SURGERIES usually improve one’s quality of life and can often prevent a later emergent surgery (and other treatments) that can occur. I highly recommend having elective surgeries performed when it improves someone’s health and/or quality of life.

Another elective surgery example is the case of a melanoma diagnosis, a form of deadly cancer that often metastasizes (spreads) to other parts of the body. ¬†Having the melanoma removed is necessary, but not an emergency surgery; the melanoma does need to be removed in a timely matter, but not within mere seconds of diagnosis to save one’s life.

Some words on COSMETIC SURGERIES … cosmetic surgeries are a sub-category of elective surgeries. ¬†Usually cosmetic surgeries do not improve one’s health in general, at least physically speaking. ¬†However, psychologically, a cosmetic surgery can often do wonders for one’s emotional well-being.

There are mixed cosmetic surgeries that serve as functional elective surgeries as well; cleft lip and palate repair would be one example.  After cleft lip and palate repair, the person can eat and breathe better, infection risk is decreased while their facial appearance is also improved.

If any one poo-poos YOUR hysterectomy as “only an elective surgery”, you can remind them that the vast majority of surgeries in the U.S. are elective surgeries and that you’ve chosen your surgery to improve your health and well-being … while kindly reminding them they are not in charge of your healthcare or medical decisions.

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THE CONFUSION appears when someone hears that a surgery is elective.  Many people have the words elective and cosmetic intertwined.  They do not have the same meaning.  Cosmetic surgery is a type of elective surgery. Simply because a surgery is elective DOES NOT mean it is not necessary.

Many, if not most, elective surgeries are necessary … for various reasons of course.

Rest in peace Huey, Dewey and Louie. Good riddance!

While UTERINE FIBROIDS were not my personal reason for a hysterectomy, this woman’s description of why she had a hysterectomy is worth reading. Fibroids (and menorrhagia — heavy vaginal bleeding) are the most common reason why women seek hysterectomy … and I don’t blame them!

fibroids

Eclectic Popcorn


Today I celebrate being fibroid-free for ten years. It seems like just yesterday that I had a limited life due to the horrible, daily pain.

The uterinefelt-uterus fibroids were discovered when I had a stomach pain so bad I ended up in the emergency department on New Years Eve. When the doctor ruled out an upset stomach from indulging in too much holiday fare, he thought that perhaps it was gallstones so arrangements were made for an ultrasound. I returned to the hospital the next day, New Year‚Äôs Day 2005, and during the ultrasound of my gall bladder there were no signs of anything that could be causing me discomfort. The ultrasound technician paused, held the wand up and asked, ‚ÄúDo you mind if I check lower just to cover our bases?‚ÄĚ. I indicated that he was welcome to proceed. I unzipped my jeans and pulled the denim out of his‚Ķ

View original post 1,540 more words

Vaginal Cuff Ad Nauseam

The vaginal cuff gets a lot of Googling … ooooh, that sounds kind of kinky doesn’t it?

I haven’t heard of any Gyn informing their patient about the vaginal cuff when they are going to have a hysterectomy … and then again, I’m not sitting side-by-side with the prospective patient either in the office. All I know is that when I bring up¬†vaginal cuff with any woman about to have a hysterectomy, the response is usually, “Huh?!?” or “What’s that?”

Uterus origami-style ... BEFORE hysterectomy

Uterus origami-style … BEFORE hysterectomy.

Having a hysterectomy itself can be overwhelming. ¬†Simply getting to that final decision of taking out the baby house is a big step. ¬†Hysterectomy¬†is a major surgery. ¬†I don’t care what anyone tells you … even your boss who wants you back at work ASAP. ¬†Comparatively, hysterectomy is a small surgery when put side-by-side to a coronary bypass, a craniotomy or a pancreaticoduodenectomy (say that seven times fast!) … but hysterectomy is a major surgery when compared to a D&C (dilation and curettage, which folks by the way is pretty much the same thing as an abortion procedure just so you know). ¬†Please don’t get all fluffy-flustered on me because I wrote the word¬†abortion. ¬†I’m only talking about it comparatively in a surgical-procedure sense; I’m not giving you one … or anyone else … ever.

Back to the vaginal cuff … the reason you’re reading this in the first place. ¬†Instead of explaining what the vaginal cuff is, I’m posting a drawing instead. ¬†Please see the end for links to my other two posts that detail the vaginal cuff.

READ HERE: HysterSisters description of the vaginal cuff and what it is (2005).

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Pre-Hysterectomy (the uterus is still here — the baby house is in da house!)

female-reproductive-system

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Post-Hysterectomy (the uterus has gone bye-bye)

Here’s a drawing¬†of the female anatomy without the uterus showing the vaginal cuff.

vaginal cuff post hysterectomy

Hmmm … I find it interesting that the vaginal canal in this picture is quite penis-shaped. Coincidence?

Maybe I’ll draw my own image showing the vaginal cuff one day and take a photo of that scribble scrabble if I get ambitious enough (nah, I’m too lazy). ¬†I do have to say as a critique of the aforementioned drawing … there is a huge chasm where the small intestines should be filling in the space where the uterus once was. ¬†It’s as though there’s an air pocket now where the womb was.

bso

That medical drawing is a total hysterectomy (meaning all of the uterus — that includes the cervix because that’s part of the uterus too) with a bilateral salpingo-oophorectomy (both tubes and ovaries).

And simply so you can be complete on all this cuffness …

I have two other posts about the vaginal cuff:

number1¬†That Vaginal Cuff Thing …

number2 The Vaginal Cuff REvisited!

Here are a couple cats just ’cause … now back to the book I’m reading.¬† The cat to the right is completely thrilled with this post as you can obviously tell.

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Support. It’s VERY important.

Support. ¬†It may be a two syllable word but it means the world to people who are going through a surgery, recovering from their own surgery or caring for another who has just had surgery. ¬†Some people are obviously better at providing support than others … this is simply human nature and the variance of personality.

Although my hysterectomy was elective with a non-cancer diagnosis I was fortunate to be surrounded by a supportive group of people to include my husband. ¬†I’m also fortunate my place of employment was supportive as well. ¬†I understand it is difficult for many supervisors to find adequate coverage when someone is absent for an extended period of time; their primary concern becomes their day-to-day operational functioning often forgetting both the personal and emotional lives of those who have become temporarily absent.

To have surgery or be out for medical reasons is the nature of being a human — eventually we’re all going to need surgery or have a critical illness at some point if we live long enough. ¬†We are after all humans and not robots.

When a supervisor is supportive of an individual who is out on leave it generally works wonders on that person’s psyche allowing them to return to work with a positive attitude and helps him or her heal in the meantime.¬† Positive attitudes can’t be forced upon the individuals in your life.¬† When possible, negative influences should be either dropped from your life or minimized during times of healing or emotional stress … and for reasons of happiness in general!

To the greatest extent possible, separate yourself from any person, place or thing that is bringing you down, is disruptive for you, unsupportive of you or otherwise harmful to your well being or self esteem. The disgruntled co-worker, the nay-sayer, the jerk next door … even the condescending relative. These negative people are like vampires and will suck the life out of you. ¬†If it is a co-worker or relative then it may be tough. Deal with them only when necessary to accomplish a task.¬† [my emphasis]¬†It doesn’t matter who it is – you have to be tough. You may have to leave them, block them or ignore them. You must not let these people destroy your joy – your passion for life.

You can’t stop negative people from being negative but you can stop them from destroying everything positive and beautiful in you. In the end you owe it to the others in your life and you owe it to yourself.

This purging applies to negative habits and routines as well. Do a self inventory and determine which practices add value and which detract from your life. Eliminate the negative immediately and entirely. No mercy here. Eliminating negative actions is just as important as eliminating the negative people in your life.

From ZenPresence: Improve Your Life Instantly.

Part of the healing process is sharing with other people who care. ~ J. Cantrell

THE blog that inspired this blog

I read about this woman’s journey with her hysterectomy. ¬†She had hers in 2011.

Here’s the link:¬† Given Eyes to See — HYSTERECTOMY BLOG

i-am-obama-care

I am Obama Care!

All I can say is wow!  She and I have some very different issues.  I cannot imagine having this surgery WITHOUT having insurance coverage.  Kudos to her for starting her blog and receiving news media along with any financial donations she got!

The post-op fun continues … sort of

day-night1

Can I just get this out right now … my day and night nurse were literally like day and night! ¬†Luckily the nurse I got to spend the most time with or who spent the most time with me was the nurse I preferred. ¬†Not all nurses are the same, just as all people aren’t the same. ¬†There’s usually a chemistry between people or their isn’t and this was the case for me and my two nurses.

Nurse S. was my day nurse; she was attentive, kind and thorough. ¬†She was also a great listener too … I’ll get into that a bit later. ¬†I was a bit sad when she had to end her shift, but she did have a life and family to go home to. ¬†She did make me feel like her only patient. ¬†I hope I didn’t make her feel that way because I know some patients can be time-hoggers and as a nurse you end up feeling guilty by not being as attentive to your other patients.

Nurse S. used to by an L&D (labor and delivery) nurse before working on this postpartum / GYN floor. ¬†I was kind of afraid coming to this floor that I’d be the boring, non-cutesy-baby-having-momma patient and might be ignored … but this is far from what actually happened.

Prior to being placed on this floor I was asked if the predominantly postpartum floor would be an OK place for my post-op recovery. ¬†I was asked this by the pre-op nurses prior to my surgery. ¬†If I was OK with being on the postpartum floor — the floor with all the brand new babies — then I would be on the general surgery floor. ¬†I was totally OK being on the postpartum floor even though I am childless.

Apparently there was an incidence of some woman in the past who had a hysterectomy, who already had three boys, who got placed next to a room with a new infant girl. ¬†That patient went hysterical after her hysterectomy because she had always wanted a baby girl; it was a trigger for her. ¬†Honestly, all I ever wanted was¬†healthy normal baby with 46 chromosomes and no major structural deformities … nothing perfect … simply an intact start for my baby’s life.

So, yeah, the postpartum floor was what I wanted; I figured they knew about women’s needs better, to include female anatomy. ¬†The only¬†weird baby situation I ran into was when I got up for a walk down the hall, rolling my IV pole and carrying my Foley bag along, was the man who walked by me and asked,¬†Boy or girl? ¬†To which I replied,¬†Neither. ¬†I had a hysterectomy.¬† He looked visibly embarrassed and apologized. ¬†His question had no effect on me emotionally; I understand that not everyone knows the postpartum floor also has GYN patients, not merely new mothers.

One thing I will have to impress on anyone who goes to the hospital is to bring snacks. ¬†I was starving after surgery. ¬†It was EIGHTEEN hours before I ate something. ¬†And, no, ice does not count as eating something. ¬†I scarfed down all the orange jello and graham crackers they would give me until my meal tray arrived. ¬†The hospital food true to clich√© was terrible with the exception of the next morning’s bacon. ¬†But when you’re hungry, you’ll eat just about anything.

As for my patients that I talk to when I return to work and if I’m every hospitalized again, I’m going to emphasize the importance of having available finger-food snacks. ¬†Holy cow I was hungry! ¬†And it sucks to beg for graham crackers and jello from your nurse when you know these are trivial items in the scheme of actual nursing care! ¬†I joked with nurse S. that I really wasn’t¬†needy but¬†wanty instead; she laughed. ¬†I also told her I might have been somewhat¬†hangry and asked her to forgive me. ¬†She had a puzzled look on her face. ¬†I can’t believe she hadn’t heard the term¬†hangry¬†before. ¬†I had to bring her up to speed.

HANGRY!She got it and a let out a small chuckle. ¬†Wish I’d known this word years ago … it explains a lot with a lot of people I know (and have known)! ¬†I don’t think I was really angry … I was only graham cracker and food obsessed … I did have a Dilaudid pump infusing into my veins by the way!

Can this post-op day really continue? ¬†Yes, it can … I’ve got some more stuff to milk this one day into a few more posts. ¬†Stay tuned.

Surgery day: June 27, 2014

As I write this, my surgery is over and I’m alive! ¬†It has been FIVE days since my da Vinci laparoscopic assisted total hysterectomy. ¬†Here’s what I had in layman’s terms: I had my uterus taken out — all of it including the cervix. ¬†It was done laparoscopically with the assistance of the da Vinci robot. ¬†My abdomen was insufflated with CO2 (carbon dioxide gas). ¬†I have four small incisions. ¬†My ovaries and fallopian tubes were left in.

I chose to have my cervix taken out because I didn’t want to have any more pap smears to contend with or possible spotting / light periods that some women have when they still have their cervix. ¬†That’s a bit mind-blowing for me — having a¬†partial hysterectomy and¬†still having a period. ¬†Plus there’s a process called¬†morcellation that grinds up the uterus, taking the ground up contents pushing them down through the intact cervix expelling them out the vagina or through an abdominal incision. ¬†If any of those uterine cells have cancer there will be remnants left behind possibly causing cancer at a later time. ¬†Who would want that?!¬†

The FDA’s stance on MORCELLATION.

I left my ovaries (and tubes) in because there is no history of ovarian cancer in my family and they are basically fine, other than being filled with old, old, old eggs — and only a few at that. ¬†I want the hormones these little guys are still producing even though their vitality must be fading somewhat as I’ve had to go on hormone replacement prior to this hysterectomy due to the night sweats, hot flashes and brain fog.

Now, on to surgery day. ¬†I had to be at the hospital at 5:30 a.m.! ¬†Somehow both my husband and I were not sleepy at this horrible hour. ¬†I checked in. ¬†I felt great. ¬†My pre-op nurse was fantastic! ¬†I was so lucky to get nurse J — she was the perfect nurse for me on this day. ¬†J happens to be the wife of my Gyn doing the surgery. ¬†J had such a sense of humor that I didn’t feel any anxiety as she kept me laughing. ¬†She too has never had children and could make jokes about being childless. ¬†This helped ease my mind because it’s nice to know there is at least one other woman in real life who didn’t think their life’s mission was to have children pushing that kind of agenda on me.

I picked my anesthesiologist a few days ahead of time and I’m glad I did because there is some reassurance in simply seeing someone you know with a smiling face that you can trust will take very good care of you. ¬†I like not feeling like just another number, just another patient. ¬†I’ll admit that I do like to feel just a bit special.

Dr. V (the anesthesiologist) asked if I wanted some versed in my IV as we rolled off to the OR and I told him no I didn’t want anything like that and wanted to be awake and conscious as long as possible to the last minute. ¬†We discussed my post-op nausea vomiting history … I have all the risk factors for being a post-op barfer. ūüė¶

  1. past history of post-op nausea & vomiting (PONV)
  2. non-smoker
  3. history of motion sickness
  4. abdominal or pelvic type surgery
  5. use of pre and/or post-op opiates
  6. female sex

For some reason non-smokers are at greater risk for post-op puking. ¬†I’m not really sure why this is … maybe nicotine is some sort of an antiemetic — that’s my best guess. ¬†But there is no way in hell I was going to start smoking before surgery to decrease my potential for PONV!

Dr. V. told me he was going to use as little gas as possible because that is what truly makes people have the most PONV and would be giving me mostly profofol (see link below).  Dr. V. also placed a scopolamine patch behind my ear to prevent PONV and told me I could wear it up to a week, but that it would probably only be active for about 72 hours.  I had a scopolamine patch with my last surgery and wanted it again.

What is Profofol (Wikipedia)?

I remember scooching over to the OR table. ¬†It was a skinny little thing and I only had an inch or so to each side of me. ¬†I asked the OR staff if this was a table picked out for my size and they told me it’s what they used for everyone with most people hanging off somewhat on both sides. ¬†(Just for your reference I am about 5’4″ and weigh 120 lbs.) ¬†I couldn’t imagine hanging off this little table and thought how lucky I was to fit.

Everyone was so kind to me in the OR the brief moments I remember them. ¬†I looked over and saw the da Vinci robot. ¬†My Gyn doctor placed the SCDs (sequential compression device) on both my lower legs himself! ¬†That impressed me because I thought only a tech or nurse would do that! ¬†Again, I have a great Gyn doc — I’m so lucky; he’s a wonderful doctor and man. ¬†Just so you know, the SCDs compress each leg at a set interval to keep the blood from pooling in the calves preventing blood clots — so they are uber important in pre- and post-op care!

The next thing that happened is that I was told I would feel a cold sensation in my IV and a mask was placed near my face while Dr. V. told me to breathe in the oxygen. ¬†That’s my last memory of the OR.

BAM!  SLICE OF TIME AND LIFE REMOVED!

The next thing I knew I woke up in the recovery room, feeling a dull achey soreness in my abdomen while my mouth felt like the Sahara Desert. ¬†I kept looking up at my vital signs — yep, only a thing a nurse would do and everything looked great. ¬†I survived the surgery and all my vital signs were absolutely normal.

My biggest concern was my dry, dry, dry, dry, dry, dry mouth. ¬†I kept begging and yes, I was begging the PACU (post-anesthesia care unit) nurse for some ice chips. ¬†It became a battle with her not wanting me to throw-up and me wanting to rehydrate my Saharan oral orifice. ¬†Heh, heh, finally I won when Dr. V. showed up and I got his formal permission to get those ice chips! ¬†Good-bye sand mouth! ¬†I know that wonderful PACU nurse was only trying to keep me safe and do her job. ūüôā

I got set up with a dilaudid PCA (patient controlled analgesia) pump and let me tell you that thing worked so well I wish I could have had it at home! ¬†My Gyn doc and I had discussed pain control during the pre-op appointment and I had explained that dilaudid had worked well in the past and that I never, ever, ever, ever wanted morphine again in my life. ¬†I had morphine in the past and it felt like my chest was being crushed and my life was being snuffed out … awful feeling.

I hung out in the PACU for however long I needed to until I finally made it to my room. ¬†I don’t know how I got from one bed to the other … maybe people transferred me? ¬†I don’t remember. ¬†I do remember having the nicest nurse in the world — and I truly mean that. ¬†If I could have drawn a picture and picked out her personality with the brains she had it would have been her. ¬†Lucky, lucky was I. ¬†I’ll call her nurse S. ¬†The night nurse was a different story, but I’ll write about that later.

When you have a major surgery you want a friendly person … you really, really do. ¬†A smiling face while you’re adjusting to your post-op status does wonders. ūüôā

More about my post-op status in another post … stay tuned.

uterine evac real