28 days post surgery and passing milestones on the road to recovery

Today marks the end of four weeks since having surgery to remove part of my bowel and cut out a mass suspected of being cancer and a stricture which had reduced the size of the gut diameter so significantly that a complete bowel blockage was waiting to happen in the not too distant future.  

At the time of writing, I still haven’t heard whether the mass visible on a CT scan was malignant or benign.  I guess I’ll find out next week when I see the consultant again.  But I’m working on the assumption that no news is good news.  If it was cancer and had spread to the lymph system, I’m pretty sure I’d have been informed by now and be discussing further treatment options.

As I’m is, I’m pleased to say that several milestones have now been passed on the road to recovery.  

All the bruising on my abdomen has faded away completely.  

I’ve stopped taking pain relief four times a day, safe in the knowledge that it’s there if I need it (haven’t so far).  

The last blood thinning med injection was self-administered yesterday, and the full sharps bin will be returned to my local pharmacy shortly.  The tiny punctures on my thighs and little bit of bruising due to my inexperienced injecting will disappear soon, I hope.  I’m not afraid of needles, but I found that sticking one in myself wasn’t that easy.  Major respect for those who have no choice but to do this several times a day, every day, forever…

The four small “stab” wounds where the laparoscopic instruments were inserted have healed beautifully, and when the stitches blow the surface have fully dissolved (it takes 6-8 weeks post op for this to happen, I’m told) the wounds should be a bit flatter compared to the small bumps below the skin I can feel at the moment.  The “disembowelment” cut along the bikini line is taking longer to heal partly because it became infected and partly because it’s where my body bends when I’m sitting down and the wound opens up and closes a little with each “creasing” movement.  

A short course of antibiotics seems to have sorted out the infection and the GP’s practice nurse says that although the wound is still weeping a little and the healing is taking longer than usual, it’s still going in the right direction.  I can discuss with the consultant next week, if it’s still a problem. In the meantime, I’ll just have to be patient and let nature take its course.  And maybe spend less time sitting down!  

I’m still in the period when lifting anything heavier than a full kettle of water is banned, but I did spend several hours walking around with my big camera at the weekend without any problems, so I’m getting there.  

Next big event on the road to recovery will be a follow up meeting on 24 August with the consultant who did the operation. Unless, of course, I get a phone call in the meantime to tell me the biopsy results…Ever the optimist, I’ve started making plans to travel and meet up with friends once I’m OK to do some heavy lifting again, and assuming that no further treatment is necessary.  And there’s a first grandchild who is due to arrive in about a months time.  Something very special to look forward to!  

Hiccup in the otherwise good progress

One of the things they warn you about after surgery is the risk of wounds getting infected.  Four out of five of mine are clearing up nicely.  However one wound - the biggest along the bikini line - is playing up.  

Last week (31 July) I was sufficiently concerned to ask the GP’s practice nurse to take a look, as a small amount of puss had come out when a patch of surgical glue detached itself. She took a good look and advised that the wound didn’t appear to be infected, but I should keep an eye on it and let them know if it got worse.  She suggested taking a photo of it on my phone, so I would have a base line to compare its appearance over time. 

I noticed over the weekend that the area was stinging and painful if I wore my usual jeans, so I took a photo this morning to compare with the one taken 8 days ago and changed back into my baggy trousers.  Sure enough, the wound looks redder/more inflamed than before and is weeping a little.  There is also a slight odour.  So…back to the surgery today to get it checked out.

A different nurse took a look this time.  She agreed it looks like an infection, but my body temperature is normal so the infection appears to be very localised around the bikini line. I’m now on a course of antibiotics and should notice an improvement in 48 hours or so.  If there’s no improvement, the redness spreads or become painful or if I become unwell or confused, I need to contact the surgery.  If I develop any of the features of sepsis, then I need to seek urgent advice.

Hey ho…it was all going so well up to now!  Still, I’m glad I erred on the side of caution and consulted the GP before it got any worse.  Here’s hoping that there will be a noticeable improvement in the next 2 days.  I’ll keep you posted…

Milestones on the road to recovery…

It amazes me to think that two weeks ago today, I was on the operating table having a length of bowel removed.  Recovery since then has been both rapid and dramatic.  However the rate of improvement is likely to slow down now, so I’ve been thinking about milestones for the final stretch to the finish line of full recovery - small “wins” I can celebrate knowing that it’s taking me closer to the end goal.  

Some milestones have specific dates, some are more like timescale periods, others are an unknown quantity, but I’ll know it when I get there.  

Bruising faded fully away

I’m nearly at that stage.  No more black, blue or green areas of bruising, just gently fading areas of pale yellow.  I think it will be gone completely in a week, if not sooner.

Biopsy results

The removed length of bowel and lymph nodes will be examined to see if the mass visible on the CT scan is cancer and, if so, whether its has spread as far as the lymph system (which would mean cancer cells could be circulating around the rest of the body already).  I was told that process takes a couple of weeks and the results would first be discussed at the Multi Disciplinary Team (MDT) before being conveyed to me.  If that timescale is correct, I will probably hear some time next week.  Fingers crossed for good news…

No more blood thinning injections

I’ve been injecting myself with blood thinning medication every night before bed since Day 3 post op (nurses did it before then).  The injections continue for 28 days, so the course of injections should be over by 16 August.  Then I can take the full sharps bin to my local pharmacy and give my poor punctured thighs a chance to recover!

Follow up meeting with the consultant

This meeting is booked in for 24 August.  Not sure what happens at this appointment, but I assume it’s to check progress and discuss any further treatment required.  If the mass is not cancer, or it is is cancer but not spread to lymph nodes, then the surgery will be curative.  Fingers crossed again. 

Ban on heavy lifting lifted

For six weeks after surgery, I’m not supposed to lift anything heavier than a full kettle.  That period should be over by 30 August, all being well.  I can think about resuming traveling when I feel ready to lift a hand luggage size roller case on and off trains and up and down stairs, an inevitable obstacle when traveling by public transport as I do.

Stitches dissolved

I’m told by the practice nurse at my GP surgery that I have stitches in my wounds which will dissolve in 6-8 weeks (so, 30 August-13 September).  I hope all the lumps and bumps along the sewing lines will also dissolve along with the stitches!  Judges in the Great British Sewing Bee would not be impressed by all the puckers and gathering…But although I’d rather have a flat seam, I’m actually not that bothered. However, it will be nice to get back to my normal underwear, rather than the big knickers I’ve been wearing to avoid rubbing the biggest wound along the bikini line.

Pain 

Pain is getting better, bit by bit.  But I’m still taking paracetamol 4 times day.  Looking forward to being able to cough and sneeze without having to hug my belly to stop it hurting.  Roll on the day when paracetamol no longer needed. Maybe when all the stitches have finally dissolved and nothing is catching?  

So…there are my milestones on the road to full recovery from now on.  I’m also working on a list of things to look forward to as I progress along that road.  But not holding my breath on any of these things until I know that the surgery has been curative.  Fingers crossed again!

A celebration

It’s just over 10 weeks since I took a phone call while traveling in Scandinavia and heard the news that nobody wants to hear - a CT scan has shown up a “mass” which looks like cancer.  Like many others before me (and many still to come I suspect) I wondered at the time how many more birthdays I would be able enjoy…or even if I would make it to the next one at the end of July…

Well, I’m pleased to say that I’m still here, very much alive and (gently) kicking and I enjoyed a birthday celebration yesterday with family: son, daughter, respective partners, daughter’s baby bump and dog.  It was lovely!  Cake with candles, fizz and other drinks, and good party food.  

As well as family, I was surrounded beautiful cards and messages sending love and positive vibes.  Thank you all so much. 

No news yet from the hospital about what they found when they examined the bit of bowel that was removed.  Maybe I’ll hear this coming week, or the week after.  I should know definitely by the time I see the consultant at a post-surgery follow up appointment on 24 August.  

In the meantime, my recovery is going well.  Less pain. Bruises beginning to fade.  Wounds beginning to heal. Walking a bit further every day, now up to 3.5 miles; not bad 11 days after major surgery.  Onwards and upwards!

Surgery and beyond

 Its now a week since I had surgery to remove part of my colon containing a “mass” which looked cancer on a CT scan, together with a stricture which had narrowed the bowel to the point where the opening was so small not even a paediatric colonoscopy camera could push through.  

Surgery 19 July

Alarm set for 4.30am to give me enough time to shower and drink two bottles of “PreOp” high carb drink and some water before going nil by mouth from 5am, two hours before I had been asked to attend hospital.  Daughter Katie picked me up at 6.30am and drove me to the hospital. At that time in the morning Oxford’s notorious traffic is relatively light, and we arrived at the hospital’s Direct Theatre Admissions around 6.50am, to find at least a dozen people waiting for the doors to open at 7am. My heart sank…but we were ushered in on time, details checked, observations carried out (weight, heart rate, blood pressure, blood oxygen levels) and questions regarding medical history, when I’d last eaten and drink and such like, answered.  I was told that I was first up, so not long to wait. 

Katie was allowed to stay while I changed into a hospital gown, had wrist tags applied and met one of the surgery team to discuss what was going to happen (and make sure I understood!).  He said they wanted to add an extra procedure to the consent form - something called a flexible sigmoidoscopy, which would enable them to pinpoint exactly the location of the stricture before operating.  I was happy to oblige.  Much rather they knew where to cut, rather than go on a mining expedition to look for it…

Then I said goodbye to Katie and walked to the the anaesthetic room to meet the anaesthetist and his assistant. Cannula inserted on back of hand, epidural injection in my back, then lying down with a mask over my face.  The next thing I remember was someone calling my name.  I was in the recovery ward.  It was all over. I vaguely remember someone saying it went as well as could be expected (which didn’t sound very reassuring) before being wheeled along to the ward where I would be staying for the next few days.  I think it must have been about 5pm, so a longish session on the operating table, followed by a wait for a bed to become available on the ward.  

In all honesty, I don’t remember much about that first evening/night, other than being woken up several times for “obs” to be taken, pain relief given via an IV tube, being hooked up to another tube giving me fluids and a catheter to take them away.  

Post Op Day 1 20 July

Early start with obs at 5am and pain relief at 6am.  I think I must have dozed off again until around 8am, when I was offered a hot drink, then followed a steam of people…a visit from the Early Recovery After Surgery Team (ERAS) to explain how that operated; physios to see if I could sit in a chair, get up and walk (I could - they had to tell me to slow down as I did a tour of the ward corridor!) 

Later, one of the doctors on the surgery team appeared with others in tow, to tell me it had gone well (I’d already felt for a stoma, and found nothing).  He said I seemed “chipper”, as I sat propped up in bed, happy and relieved that there was no bag.  He also said that many people feel a bit down on day 2 post op as the anaesthetic and IV pain relief drugs used in surgery pass through the system, so not to worry if that happened - it was normal.  I was told I could eat as well as drink, which seemed amazing so soon after surgery. 

The IV pain relief and catheter tubes were removed, along with the cannula in my hand, which promptly swelled up rather alarmingly.  Without giving you too much information, I did a lot of peeing on and off after that, but found it difficult to empty my bladder completely, as confirmed by a bladder scan.  There was also some blood loss from my rear end, but the doctor said not to worry - it should stop soon (which it did).  

I did start eating, but carefully - soup, jelly and ice cream for lunch, and a morsel of chicken and some mashed potato around tea time.  Funny how you remember details like that, but it was a BIG thing to have solid food again!

Katie visited and it was lovely to have company again. 

Post Op Day 2 21 July

Hallelujah!  My bowel has woken up (nurse’s term!) and that seems to have cleared the bladder blockage too.  My digestive system is fully operational.  What a relief!  My appetite returned a bit more too.

I went for 2 walks (four times the length of the ward), spent 2-3 hours sitting out of bed reading and watching TV on the laptop, and ate three meals as per the ERAS advice.  But the surgery drugs have definitely gone through the system, and it’s really painful to move between lying down, sitting and standing i.e.movements which put a strain on core muscles.  I need the pain relief when it’s delivered.  

The consultant in charge of the surgery called in, with a posse of doctors.  He confirmed that all had gone well.  There was plenty of colon left to join up the two cut ends without the need for a stoma/bag, which was something they’d been worried about.  I was medically fit to be discharged, the only box yet to be ticked was learning how to self inject blood thinning meds, which I have to do for 28 days after the operation.  My first lesson is self injection was that evening…

We all agreed I could go home on Sunday, post op day 4, when family would be at home to keep an eye on me. 

Post Op Day 3 22 July

I continued with the ERAS advice, going for three walks today covering 6 lengths of the ward corridor.  When Katie visited she bought a big fluffy bath towel so I could dry myself in comfort after showering.  When she left, I accompanied her down three flights of stairs and climbed back up again on my own without a problem.  That was reassuring.  The wounds are still very tender, bruising is spectacular and pain is bad when I change position…but it’s still early days, and it will get better.  

Very tired after a broken sleep the night before, but ready to go home tomorrow. 

Post Op Day 4 23 July

Home today!  The usual morning and lunchtime routine in hospital, wounds checked and all obs OK.  I had a farewell visit from the main consultant to wish me luck.  Apparently I’m a model patient!  

Katie arrived early afternoon and I said goodbye to everyone. Actually felt a bit emotional at some of the nice things the nursing staff said…

Afternoon and early evening at Katie’s house, then back home to wait for son Jack and his fiancé to arrive.  They will be staying here and acting as my immediate support system, until I’m ready to live completely independently.  Self injected blood thing meds without a problem, and then to sleep in my own bed. Bliss! 

Post Op Day 5 24 July

First full day at home, taking it very easy.  Jack and I walked a circuit round the park at the end of the street at lunchtime (about half a mile), so I can keep up the ERAS advice. Afternoon nap, a bit of very light housework (folding/hanging clean laundry) and an evening in front of the TV.  

Post Op Day 6 25 July

Woke up early but rested after a good night’s uninterrupted sleep.  Made myself a cup of coffee and went back to bed to catch up on emails and news.  One of my friends offered to join me on my daily walk - twice round the park this time, just over a mile.  Onwards and upwards!

A member of the ERAS team phoned to see how I’m doing: all OK, although I need to make sure I’m drinking enough to stay hydrated.  She suggested I take a Tramadol (opiate based pain relief) if the pain gets too much.  I’ll try not to as it’s addictive, but it’s good to know it’s there if I need it.  

I took a nap after my walk - and realised that I’d curled up on my side for the first time, without thinking about it or being bothered by excruciating pain.  That’s good!

However, my abdomen looks like I’ve been a victim of knife crime - four puncture wounds above and below the navel and at the belly button itself, and a longer slit along the bikini line (where the bowel was pulled out) which has given me a sort of muffin top around the hips.  More bruising has appeared, not just around the wounds but in other areas too.  Black, blue, green, yellow…quite colourful…an indication of the punishment my body has taken.  One of the doctors advised that the bruising would eventually fade from the top down, aided by gravity.  The last thing to disappear will be what appears at first glance to be a dark blue bikini bottom. It’s not, it’s just a bloody great area of bruising!  

Ironically, the area that hurts the most when I change position is close to, but not part of, the main wound and is not particularly bruised.  At least, not yet.  It’s a fierce stinging/burning pain deep inside.  I wonder if it’s muscle damage?  Must keep an eye on it, and take action if it’s still hurts as much when the bruising has faded.  

The final countdown 5-4-3-2-1

I’m in the final countdown before surgery, and keeping everything crossed that my operation won’t get bumped again…all the more so, bearing in mind that currently the appointment is slotted in between the end of the junior doctors strike the day before and the start of the consultants strike the day after the scheduled operation.  

I’ve been trying to stay positive and making the most of these last few days as who knows how life will be post surgery - assuming all goes well, of course.

Five - 14 July

I did rehabilitation walk #12, just over 3 miles (apparently, the fitter you are pre-surgery, the quicker you recover post-surgery).  My fitness trends are looking good!

Four 15 July

A bit of a mad scramble in the morning to clear/clean up and prepare a nice lunch for a friend visiting from America, who had phoned yesterday to arrange a last minute visit.  It was good to be sociable for a change, and we did my Prehabilitation Walk together (3.15 miles).  

After he left, I started sorting out the items I need to take into hospital with me and prepared an old phone by removing sensitive information so that I can take it in with me to communicate without significant risks if it gets lost or stolen.  

Three - 16 July

Time to do a few household chores before setting off on Prehabilitation walk #14, along the Oxford Canal to the Library of Things which was holding a “repair cafe”.  My pressure washer has never worked properly since it was bought and is now completely dead.  I was hoping they could resuscitate it, but no luck.  Still I did manage to clock up another 3+ miles and avoid the rain.  The afternoon was spent watching the thrilling men’s Wimbledon tennis final, and catching up with a few emails.  Still many to answer…

Two - 17 July

I have started packing for my stay in hospital.  The advice is somewhat contradictory, but it seems like they want you to arrive with the bare minimum - nightclothes and toiletries, a book/magazine and any essential medical stuff (I assume that includes glasses and hearing aids, as well as any medicines). I will also pack an eye mask and noise reducing earbuds.

The person who accompanies you Theatre Direct Admissions, then takes away any non-essential stuff like bags and coat. They are then expected to bring you clean day and night clothes and anything else you need once you are back on the ward recovering post operation.  So…two bags it is!

As well as “Prehabilitation” walks, I’ve also been preparing mentally for recovery.  Depending on the source of information, I could be in hospital anything from three to ten days, which makes planning ahead a bit difficult!  However, this is generally what I can look forward to:

Day of surgery - sit up in bed, sit in chair, have something to drink 

Post op Day 1 - sit in chair twice, go for two walks, have something to drink

Post op Day 2 - sit in chair twice, go for two walks, have something to eat

Post op Day 3 - sit in chair twice, go for three walks, eat, drink and get dressed

I’ll be allowed to go home when assessed as medically fit for discharge; effectively controlling pain; eating and drinking with no nausea or vomiting; able to get out of bed and on/off toilet independently; independent with stoma care (if applicable) and competent with administration of blood thinning injections (if applicable).  

I did my penultimate prehabilitation walk along the Thames and Cherwell revivers and around the Botanic Gardens, which was lovely.  

Still no call from the hospital, so it looks like the surgery is going ahead..

One 18 July

As I don’t know when I’ll be able to wash my hair again and it’s getting a bit unruly, I treated myself to a visit to the hairdressers this morning.  The walk there and back was my last “prehabilitiation” walk before surgery tomorrow.

Around midday, I started bowel preparation - 10 senna tablets.  I don’t need to tell you what that does!  And shortly after that, I phoned the hospital to find out what time I should arrive.  The answer?  7am.  Looks like I’m first on the list.  Early night tonight ready to meet up with daughter Katie at 6.30am as she’s taking me to hospital.  

The rest of today will be taken up with bowel preparation.  Two doses of stuff called Citramag at 2pm and 5pm designed to cause severe diarrhoea; four drinks of “PreOp” today and two tomorrow before 5am, a high carb drink to give me some energy; half a pint of water every half an hour to keep me hydrated.  No solid food and only clear fluids between now and 5am tomorrow morning when its nil by mouth until after surgery.  

It’s real.  It’s going to happen.  Tomorrow. Not sure when I’ll be able to update the blog again.  Please check back in a few days time…Wish me luck!  

I now have a series of appointments with the loo….

Prehabilitation

Confession:  the news that by surgery planned for 5 July had been bumped to 19 July was an emotional blow.  I felt like the wind had been knocked out of my sails; totally deflated and drifting off into limbo land where hours pass, little happens, nothing is achieved…

But the lethargy started to lift with real life and cyber support from family and friends, and a day out in Bristol at the private view/opening of the Royal Photographic Society’s Summer Exhibition - in which I have a print - has helped get me get back on track.  

Rather than get stressed again about the further delay, I’m going to start “prehabilitation”.  This is defined as “a process of improving the functional capacity of a patient prior to a surgical procedure so the patient can withstand any post operative inactivity and associated decline”.  In other words, to get you to a better place physically before you have an operation.  

You do this by:

Improving your diet

For me, that means trying not to respond to stress by eating comfort foods like chocolate and savoury snacks which spoil my appetite for healthy meals

Cutting down on alcohol

I usually restrict my alcohol intake to a bottle of wine at weekends and a drink on special occasions, so I’m already below the recommended limit. But maybe I should experiment with some mocktail recipes…

Stop smoking

I stopped that years ago whilst pregnant, so already ticking that box

Increasing activity

One of the upsides of lockdowns was going out everyday for a walk.  With the easing of restrictions, I lost that daily habit. I’m going to try to revive it, aiming to walk at least 5km/3 miles every day.  I’m posting on Strava, calling them Prehabilitation walks.  Give me some kudos so I keep going!