Tag: post-surgery advice

(Not so) fun times with endometriosis. (Part Four)

I am finally writing my fourth (and I think last) instalment of posts about my surgery for endometriosis earlier this year. It’s been a long time coming, but that is in part because I have been incredibly productive in other areas of my life – yay! But that is a whole other post.

Previously, on Living With the Fibro Troll….

In part one of this series I talked about what endometriosis is, and how the hospital system works in Australia and what to expect prior to surgery.

In part two I gave some advice for practical and helpful (I hope) things to do in preparation for surgery.

In part three I talked about the initial post operative period both in the hospital and at home.

EDIT: I added an addendum recently to include a book and a support group recommendation.

***

This part is about the more extended post-op period. The first few days are not much fun, but if you keep on top of your pain relief, manage not to get constipated and make sure to rest, in some ways they are easier than the next couple of weeks.

Our society seems to have gotten into this “just power on” mentality. The idea that you should push through the pain and that taking time to rest is somehow “wasting time”. Everyone, especially FibroWarriors or anyone with chronic health conditions, needs to ditch this idea. Particularly post surgery.

Your surgeon might give you instructions to “go back to light duties” within a few days after surgery. This is fine advice, but doesn’t take into consideration that chronic illness suffers often have prolonged recovery times from ANYTHING and also often have less conditioning so will take longer to recover.

Do not expect to be able to go back to your regular routine straight away. It can be weeks or months before you are back to normal and it can take several cycles for your period to normalise.

GIVE YOURSELF PERMISSION TO REST!

The little incisions on your abdomen might not look like much, but they are just the access points. Your abdomen has been inflated and stretched and poked around in. Endometriosis lesions were removed, and they can be from anywhere and could be extensive. All of those excision sites need to heal.

If, like me, you have endometriomas removed from your ovary/s, then your hormones may be affected. In fact, you will have increased cortisol to deal with whether or not your ovaries were involved. You have to process the anaesthetic drugs and the pain relief drugs.

And then you still have to deal with the FibroTroll. The FibroTroll doesn’t take holidays, not even if you have surgery. So rest. Then rest some more. Even if you are bored witless. Rest.

***

Move your body.

This kind of sounds like that opposite to what I just wrote, but I am NOT saying to go for a run or to start lifting weights.

However, some movement is essential for healing. Your lymph system does not have a pump like your vascular system does (your heart). You need to move so that your lymph can move also. This is super important for your immune function.

Set a timer and every hour – stretch. Stretch your arms, point and flex your feet and make circles with them, roll your shoulders, turn your head gently from side to side. Give yourself a gentle massage, and if you have someone willing, get them to massage your lower legs with firm strokes up your legs. While they are down there, there’s a reflexology point between the ankle and the heel that when pressure is applied can help some people with uterine pain.

As you heal, SLOWLY increase your activity. Keep your timer for every hour, and every second time, get up and walk a short distance. By short, I mean wander slowly around the house, maybe go out to the letter box if you have a low-set house and you live in a regular sized suburban property. Then GO BACK TO RESTING. If you have to do household tasks like cooking and cleaning, do it in stages and rest in between. This counts as movement, and will use energy. Allow for that.

***

Dealing with referred pain.

Your body is an amazing, complicated, confusing thing. It will heal those incisions that were made in your skin. There will be a small scar, but it will heal. It does, however, sometimes do some strange things.

Remember how I mentioned that the surgeon will fill your abdomen with gas so they can see what they are doing and get to the bits that need removing? Well, they do the best they can to remove that gas at the end, but they generally won’t be able to get all of it out.

There’s no need to panic about this,that gas won’t get into your vascular system and kill you. It is outside your organs and has to slowly work it’s way out. In the meantime it feels very strange to roll over and have this gas bubble it’s way around your abdominal organs to rest at the highest point it can get to.

The really strange thing about this gas is, that when it lodges up under your diaphragm, (a big, flat muscle that separates your chest from your abdomen and helps you breathe), you get a referred pain in your shoulder. This is thought to be because of irritation to the phrenic nerve which innervates your diaphragm.

There’s a few things you can do to help your body get rid of this gas and relieve the pain caused by it.

  • Drink plenty of fluids
  • Avoid constipation (see part 3 for my “pooping porridge”recipe)
  • Gentle massage of your abdomen – always in a clockwise direction
  • Drawing your legs up to your chest when lying flat on your back, if this does not cause you excessive pain.
  • Heat packs
  • Gentle walking
  • Lying on your side when resting – the gas will move to the highest point, hopefully reducing the irritation of your diaphragm
  • A drug called simethicone  (marketed as De-Gas in Australia) – check with your Doctor first.
  • Getting off the opioids as quickly as you can – opioids slow your intestinal system and you want that moving to help gas movement.

***

Getting back to normal

Time. Really, this is my biggest advice post surgery. Give yourself time.

It’s really hard to do. And if I need to have surgery again in the future, I will need to write this down in big letters and put it somewhere I will see constantly.

Healing will happen. Your body is an amazing, self healing machine. You didn’t grow those endometriosis lesions in a couple of weeks. Give yourself longer than that to recovery from surgery. If you break a bone in your leg, you don’t expect to run a marathon 6 weeks later. The bone might be healed, but you would give yourself time to recondition that leg and allow it to build up strength.

Do the same for yourself post endometriosis surgery. That broken leg would have been in a cast or pinned, or otherwise kept immobile. Your incisions from surgery will probably heal in 6 weeks, but you can’t rest your entire abdomen for that time. Your intestinal system keeps working, your ovaries develop follicles and ovulate, your uterus will most likely shed it’s lining at least once, if not twice in that six weeks. Your bladder will fill and empty many times. Nothing will be immobile in there.

Practice compassion towards your own body. Give it kindness and good nutrition. And most of all give it TIME.

***

I hope this series has been of some help. If you are about to undergo surgery for endometriosis (or anything else) good luck and I hope you heal quickly and the surgery achieves the desired outcome.

I linked them at the start, but to save you scrolling back to the top you can go back to part one, part two, and part three, by clicking on those links.

(Not so) fun times with Endometriosis. (Part Three – the first few days post op.)

Here is the next instalment of my series on Endometriosis. In Part One, I discussed my recent surgery, and in Part Two, I wrote about some things I did pre-surgery that helped things go as well as they could. This one is about the initial post operative experience.

As I briefly mentioned in Part One, I woke up from my anaesthetic in a fair bit of pain. The staff were lovely, and were quite determined to get me down to no pain. Now this is something most FibroWarriors are unfamiliar with.

I am fairly lucky as far as my Fibromyalgia pain goes. If I’m good with my diet, supplements and self care, I generally function at a constant 2 or 3 out of 10. I know there are a lot of FibroWarriors that are having to deal with constant pain levels much higher than that. But the idea of getting my pain to zero, is kind of laughable. I am not good at lying to people at the best of times, but coming out of an anaesthetic meant that it was virtually impossible. So when they are asking me what level my pain was, I responded honestly. The difference is, that while I would have been happy for them to just get my pain down to a 2 or 3, they wanted it at one or zero.

I’ll be honest, they did not succeed, but the anaesthetic wore off enough for me to convince them that my pain was low enough to stop giving me drugs.

Tips for while you are still at the hospital

I don’t really have a lot of tips for post operative stuff while still at the hospital. Of course there are the things that should be common sense and basic human decency. Follow the nurses’ instructions, be polite even if you are in pain. Use your manners, and remember that ALL of the hospital staff are people doing their jobs. There is never an excuse to be rude or abusive, especially towards the very people who are trying to help you.

They will expect you to eat and drink (and keep it down), dress yourself (at least to the level that you normally can) and go to the toilet before they will discharge you. This isn’t them being difficult, it helps them to assess if you are okay to be discharged. If you can’t do any of those things, it might indicate that you need to be monitored for longer than normal. It might just mean you need a few more hours, or it could be an indicator of something more serious. Don’t kick up a stink if they want to keep you, they are recommending the best thing for your health.

Don’t be afraid to ask the nurses for help. If you need an ice-pack or a heat-pack , or your pain levels have gone up, or you feel nauseated, talk to them. They would much prefer to get you a vomit bag and you end up not needing it, versus you trying to fight through it and vomiting on the bed/chair/floor. Just be polite and make requests rather than demands.

Being discharged

Check that you understand the discharge instructions, ask questions if you need to.

Check if you need to collect any medications from the pharmacy. I was lucky that it was pretty quiet when I was being discharged, and one of the lovely nurses took my prescription down to the hospital pharmacy to be filled, so that it would be ready for the Knight to collect once he arrived.

If it is not already recorded on your discharge information, ask the nurses to write down what medication/s you have had and at what time/s. This will help you take your next dose at the appropriate time.

If you have a long drive home, use the bathroom – a full bladder is not a fun thing to have so soon after surgery.

Travelling home

I strongly recommend a cushion or a piece of foam for the car seat. Also a small soft pillow that you can place between the seat-belt and your abdomen. Make sure it is small enough to not interfere with safety, but enough to provide a bit of cushioning.

If you are prone to travel sickness, make sure you have a bucket or a bag just in case. If you do vomit – call the hospital for guidance.

At home

Check what time you are able to take the next pain relief medication. Write it down and set an alarm. Does it need to be with food? If so, have something ready like a piece of fruit or some yogurt or one of those tasty high fibre treats you made when following my pre-op advice!

For the next 48 hours (at the very least!) take your pain relief when the next scheduled dose is due. Don’t muck about with post surgical pain. There is a valid reason why your body is giving you pain signals, it’s to make you be still so you can heal. But we, as intelligent humans are able to make the decision to be still without having pain, so take the medication!

Post surgical pain is much easier to keep down if you take the doses as prescribed, rather than waiting for it to completely wear off then trying to get it back under control. If you wait until the pain is high again, you will often need to take more medications and at a higher dose than you would have otherwise.

Avoiding constipation

You will likely be prescribed some sort of opioid medication. One very common side-effect of opioids is constipation.

Trust me, constipation post pelvic surgery is something you want to avoid.

Here are some tips for helping reduce the chance of developing constipation:

  • Eat high fibre foods. Lots of vegetables, whole grains (if you tolerate them) and fruit.
  • Stay hydrated. Drink lots of water or herbal tea, and keep caffeine to a minimum.
  • Add supplements that draw water into your stools – things like chia seeds and psyillum husks. See below for a recipe for a chia seed pudding that the knight has nicknamed “Pooping porridge”. It’s really quite tasty despite it’s name!
  • Use a foot stool or “squatty potty” to place your feet on when you sit on the toilet – raising your knees above your pelvis helps to put everything in the right position so you can pass stool with minimal straining.
  • Gentle massage of your abdomen and pelvic area – do this very gently and always in a clockwise motion to encourage things to move in the right direction. Not only will this help the movement of your bowels, it will help your body to get rid of the excess gas from the surgery that will have been left behind.
  • If these things don’t work, talk to your pharmacist or doctor about stool softeners and laxatives or consider using a microlax enema. They aren’t much fun, but the longer the stool sits in your lower bowel, the more water will be drawn out of it, and the harder it will be to pass – so don’t leave it too long!
Pooping Porridge
  • 1 apple
  • 1/2 cup water
  • 1/2 cup coconut cream
  • 2 tbsp chia seeds (Australian metric tbsp = 20ml)
  • 1 tsp psyillum husks
  • spices to taste – I like cinnamon and cloves or vanilla
  1. Chop apple into small pieces and stew for 15 mins in a small saucepan in the water (you could also use pre-made stewed apple).
  2. Add coconut cream and gently warm
  3. Remove from heat and stir in remaining ingredients. Allow it to sit for a while for the chia seeds and psyillum husks to absorb the water. Adjust to your preference – add more water if it is too thick, more chia seeds if too thin.
  4. Serve with some nuts or extra fruit, or just eat it as is – enjoy!

Try it with different fruits such as mango, pear or berries.

In my next post, I’ll talk about movement, exercise, referred pains and trying to get back to normal.

Go back to Part 1, or Part 2, or forward to Part 4 and my recently added addendum.