My Fitbit alarm gently woke me from my valium-induced slumber at o’dark thirty the morning of my DIEP flap surgery. Thanks to one of those little pale pink pills, I slept pretty well the night before, but that doesn’t mean I was still happy to be rising before the sun.
First order of business was to chug the pre-surgery carb drink they had given me the day before. A relatively new addition to the pre-surgery regime, some surgeons have begun to eschew the long held belief that a patient should have absolutely nothing to eat or drink after midnight the night before their procedure.
Back at my consultation visit in May, I asked the doctor if they followed ERAS (Enhanced Recovery after Surgery) protocol, but they weren’t at the time so I was pleasantly surprised to hear at my pre-surgery appointment that the doctors at the Center had decided to experiment with (at least) part of it. (They could also be practicing more of it, too that I’m just not aware of.)
I first learned of this addition to patient health thanks to Terri and her wonderfully informative DIEP C Journey blog. More and more doctors are putting this protocol into practice since the study in the Journal of American Medical Association (JAMA).
“The care protocol is based on published evidence. The ERAS Society, an international nonprofit professional society that promotes, develops, and implements ERAS programs, publishes updated guidelines for many operations, such as evidence-based modern care changes from overnight fasting to carbohydrate drinks 2 hours before surgery, minimally invasive approaches instead of large incisions, management of fluids to seek balance rather than large volumes of intravenous fluids, avoidance of or early removal of drains and tubes, early mobilization, and serving of drinks and food the day of the operation. Enhanced Recovery After Surgery protocols have resulted in shorter length of hospital stay by 30% to 50% and similar reductions in complications, while readmissions and costs are reduced.” – JAMA Review March 2017
Super happy to see such a paradigm shift in how the patient feels and recovers is being adapted and it was also nice not having a rumbling stomach that morning. My stomach was “rumbling” enough for other reasons.
Arriving at the hospital at 6 for my 7am surgery, I didn’t have much time to contemplate life as I was quickly taken back for the pre-surgery prep. Also different from my previous surgeries at “regular” hospitals, was only having to be there an hour before surgery instead of two. Well, this night owl thought that was just swell.
I had met with the chief anesthesiologist at my pre-surgery appts the day before and discussed previous issues, etc., so there wasn’t as much to go over, but I did meet another one of the doctors on his team. I can’t stress enough again just how kind everyone was and that they listened. While I was looking forward to the surgery (and getting it over with), I wouldn’t say I was super psyched about it that morning as the jitters set in. But everyone at St. Charles Surgical Hospital helped put my mind at ease with their professionalism and their compassion. I think you can tell by the photos, that I was not really stressed out.
Oh, and the nurse who put in my IV nailed it on her first try, which usually doesn’t happen. Many times I’ve had to have several attempts (ie. painful needle jabs) made in different areas of my arms and hands in search of my reticent veins. Doesn’t mean I still exactly enjoyed it, though.
In addition to the ERAS helping with my post surgery experience, I have to also give credit to my Meditations to Promote Successful Surgery recordings by Belleruth Naparstek that Bill put on my phone for me. I can’t remember how I was lead to it, but when I saw it on Amazon, I thought trying it certainly couldn’t hurt. I listened when going to sleep several times in the weeks proceeding my surgery and have no doubt it helped. I still picture my “band of allies” when I need them and the doctors allowed my to play the affirmations section during the first 30 minutes of my surgery. Even just listening to her voice was super calming. Highly recommend if you’re undergoing surgery of any kind in the future..
And then right on time, it was time for me to go. I hurriedly pulled up my recording and put in my ear buds while one of the nurses said she was administering medicine through my IV that would help me relax. After asking her if it would make me go to sleep or just relax, she confirmed it would relax me, as well as allow me not to remember the moments preceeding taking me back. Well, it relaxed me all right. So much so that I was OUT cold. Colder than Stone Cold Steve Austin. And yea, I don’t remember anything after the following photo. Lights out.
Approximately seven hours later, Bill was told all went well and I’d be in recovery for about an hour and a half, maybe two. Four hours later I was finally brought up to my room where he had been able to work all day from. Turns out that I lost a lot of blood during the long operation and my blood count wasn’t very high to begin with so afterwards while in recovery, my blood pressure was low enough and my heart rate high enough to give them pause, so they ended up giving me a blood transfusion. In all my surgeries, I’d never needed one before, but I also had never had so many surgical areas open, and open wide, in one operation before either.
Unfortunately, though they forgot to tell Bill why my post recovery was taking longer. Oops. Thankfully though that was a rare drop of the ball on their part and just as he was about to inquire about the delay, they wheeled me in.
I only remember being wheeled through the door and seeing Bill stand up from the couch. Then out again.
Never in my life have I awoken from anesthesia and not been nauseous. That in itself feels amazing especially given that surgery was over 7 hours. But I wasn’t this time. Thank ERAS, thank surgery CD, thank my RTT session, thank my super competent medical team….whatever the reason and it was probably a combination of all of them colliding — I was just very grateful that I did not experience that awful side effect this time. I also had a sweet little pain pump that delivered a wonderful little shot of morphine upon demand and so I was generally more headache free than I had been in the past, as well.
Unfortunately, my low blood pressure persisted throughout the night and into the next day. The first night you’re in the hospital, they wake you up and check your vitals every hour. It got to the point that anytime my systolic pressure eeked past 90, the nurse or technician let out a little amen. I also heard a “thank you, Jesus” at one point early the next morning from one of the nurses!
My numbers finally started rising the following day after one of my favorite nurses had me “eat” three salt packets like you get at the McD’s drive thru (but sans fries?! Rude!), chased by a gulp ton of water. She was not my favorite at that particular time, however. Our five year old nephew who loves eating salt straight would have been in heaven, but me, not so much. BUT it worked! My BP slowly continued it’s upward trend the next day and she was once again my favorite nurse.
Stay tuned for Rewind: The Hospital Stay