upcoming surgery

Goodness you have me wondering to. Hopefully someone or Dr. google can help. Best wishes Glennie.

Glennie, I think it's important to know what to expect from your LE under these circumstances, so do talk to your therapist about that. According to a friend who's had this surgery, it's likely you'll have some temporary neck and facial swelling, so here's a self-mld routine for that:

http://www.aurorahealthcare.org/FYWB_pdfs/x23169.pdf

There's more than one way to perform a hysterectomy, some of which I believe don't require the extreme positioning. Have you talked to your surgeon about options?

Might be a good idea to be clear with your surgeon too about your elevated infection risk (cellulitis), so that s/he can be on top of antibiotic use before and after surgery.

I think you've done a fantastic job of getting yourself in shape and fit for this, and seeking out the information you need to manage it all with success. You rock!
Binney

glennie, Hi it's sassy I'm an old OR nurse too. Lot's of old experiences, LOL. For Laproscopic  assisted hysterectomies, the angle of the table is only slightly at a head down angle(10-20 degrees)  or not adjusted at all. The leg position varies depending on the procedure. There  are specially designed leg mounts for laproscopic procedures.

You will be on your back with legs up, but comfortably up.

The shoulder pain that is experience by many has to do with a couple of things. Gas is introduce into the abdomen to effectively create a bubble. The bubble raises the abdominal wall away from the abdominal organs. That's why Laprocopic works. The abdominal wall has many muscles in it, the gas raise them away--Voila the doc has room to work The reduced recovery time from Laproscopic surgeries is b/c none of those muscles had to be cut.

Why the shoulder pain? At the end of a laproscopic procedure, in the steps of removing the instruments a VERY kind surgeon will take an extra moment to allow the escape of the gas. Important step. ASK your doc to be so kind. He/she will look at you and ask how you know that it can help. LOL, tell them you've studied.

Even in the situation of a very kind surgeon, there may be shoulder pain after surgery b/c not all the air is released.

What happens then is when the patient assumes an upright position, the air in the abdomen will go up to the highest area which is under the diaphragm. On the underside of the diaphragm is the PHRENIC nerve. The phrenic nerve when irritated i.e by the gas/air in this situation, refers(sends too) the pain to the shoulder. >>>>>>It's not that the shoulder was involved in anyway except as a signal that the phrenic nerve at the diaphragm  was irritated.        Surely hope that was clear. Because if it was,  you understand more than even most nurses do.

One of the things you can do to help the shoulder pain is to lay flat. That causes the remaining gas to redistribute underneath the belly side of the abdominal wall i.e. takes it away from the Phrenic nerve. The Phrenic nerve is less irritated and the result is pain goes away. Over time the gas absorbs into the system and is carried away.  

Le recommendations by Binney and others are good to go recommendations. Hope my explanation of the surgical info helps. sassy

Carol sassy

mcgis, the problem with leaving the uterus, is it's a non functioning organ. Not sure what your risk factors related to it being left in place i.e uterine cancer? My browser is just giving me problems(fits) for searching right now. Perhaps Binney has an opinion?

Yoohoo Binney?

Glennie the uterus doesn't produce any hormones. I always thought in terms that why have something that can make trouble later on--get it out. Now I would like to know long term risk facts. I'm curious to see what Binney has to say. I may try to find something on the internet. Is there a syndrome for "Shaken Computer"?

On my being stuck on the SLN side. There was an at length discussion in the preop area. They said they were going to do it. That's why I said so strongly that they couldn't. Knowing how strongly I felt and that I was signing the consent, it would be totally with in character for me to have written it as an absolute exclusion on the consent. I never retrieved the consent from Medical Records. I would have if LE had occurred, you can bet your sweet  bippy, I woulda.

Post-op in ICU when I had my wits about me. I questioned them hard. I examined the right wrist area, where the arterial line would have been attempted. The arterial line needle is a horse needle compared to a standard IV line. There would have been a mark for several days. Two attempts, two holes.  Nada. I hate to say they faked the report to be able to justify using the left side. That, oh so, goes against all I know and believe. But the facts are as stated. No marks and record says two attempts. Examined by me around 6 hours after surgery ended and in ICU.

I haven't written about this on BCO before. BUT your concern, is/was my concern. I thought I had it all covered, to prevent use. DS present, Anesthiologist, CRNA, and CRNA trainee, Anesthesia resident(5 total).......it was a big debate. I even, was egotistical enough that I thought it was a great learning experience for the resident and CRNA trainee. It was the reverse. That's part of why I'm very interested to know if Binney has an opinion about this.

Sassy, yikes! Really glad you had no repercussions from that arterial line, but no thanks to the "healthcare" team for endangering your health.

Educating them pre-surgery is a good idea, but maybe take it a step further and provide them with the information in writing. Jobst had (and may still have--haven't checked) a booklet called "Lymphedema--management today" that is meant for professionals and is graphic enough to get their attention. They're free for the asking. StepUp-SpeakOut has a page written by a doctor for medical folks that you can print and pass out to everyone too. It's here:

http://www.stepup-speakout.org/essential%20informa...

You can highlight any areas in that document that you want to emphasize. I have multiple copies of both with me and hand them out liberally, telling them something like, "Wow, here's the latest on LE management, the field is changing so rapidly I know it's hard to keep up!" 

Ask your surgeon if you can wrap your arm for surgery--definitely a plus during recovery as well. Some will allow it, as the arm is draped anyway. I've wrapped mine in the past, after writing on the arm first with permanent marker (comes off later with alcohol), because we have a gal here who woke up to find her bandages off, stuffed into a bag under the bed, and a bp cuff pumping away on her arm. I also wear a G-sleeve over my wrapped arm, but you can wear one on your arm without wrapping too. I get mine from the G-sleeve site, but on another thread recently someone mentioned you can get them from the American Cancer Society catalog now too (I think the catalog is called TLC). The neon-pink alert bracelets are free from the ReidSleeve people here:

http://www.lymphedema.com/alertband.htm

If you're going to wrap your arm, ask for two bands, because one doesn't fit around a wrapped wrist (I tape them together).

One gal awhile ago wrote prohibitions on her arm and then had her surgeon sign her arm before surgery, and pointed the signature out to everyone who came within range. That seems like a good plan to me, though it's no guarantee either. Once you're out cold, you really have no say in the matter.

In talking pre-surg with the anesthesiologist (who's the most likely to violate my arm), I always try to throw in the thought that since the circulation in my arm is compromised it's a bad place to put anything like drugs or hydration, since he then won't be able to predict how efficiently it will be distributed to the rest of my body. That usually gives them pause.

Essentially, our LE is most in danger when in hospitals, doctor offices and other medical settings. That's a pathetic set of circumstances, but knowing it's true does help us prepare to educate and strategize.

Still, why on earth is this our job?!

Hugs all around,
Binney

Oh Binney, what great info Thanks. Incredible info to know pre-op on LE prevention.  I write all the time on things on how to protect ourselves from our caretakers. I know some people think I over do it.........until they have "something happen"........

Binney any opinion or sources re: leaving the uterus and cervix. I know there has to be some discussion on the topic someplace. It's a perfect topic for someone to have done a retrospective meta-analysis.You'd think an oncology, gyn, public health Fellow would have grabbed it for the publication requirement.

glennie, I'm going to put in a post-op incision/ wound care thread link and the port thread that I've mentored for several years. tbird 57 wrote the port placement topic box and it's excellent. BBL

 Glennie, I can't address a single chemo drug question, but other areas do have experience. Port thread link, tbird 57's description is as pertinent today as when she wrote it years ago. Over time the only thing that may change is the antibiotic. Any one Stage IV will know this inside and out, but never know who reads this stuff  The pre-op prep is basically the same for all procedures. Infection outcomes are better if an antibiotic is given one hour pre-op. Staff really tries to time it right.

I linked to page ten b/c I posted about several pre-op things and then some post op things. They apply to any surgery. I noticed as I was scrolling that I talked about doing a colon prep before surgery. Most docs will have you do this and provide specific instructions. A colon prep is, particularly, important for any BELLY(abdominal- correct term) surgery. I did mention Magnesium citrate. That's one approach, if the doc doesn't give clear guidelines, but I'd do it two days before, avoids the leftover squirts, then low residue or clear liquids. A properly prepared bowel pre-op can make a world of difference post-op in comfort and pain.    Link to Port thread.

https://community.breastcancer.org/forum/69/topic/721889?page=10

This is a thread that I worked allot on re:incision and wound care. It's where I met SHE(waving and smiling). Blew my socks off when SHE said in Ghana her friend had to be sent home  b/c they only had one bucket of water for the OR that day.......Plus, when SHE said she had poured over the WHO manuals to find post -op care info for her friend and SHE said  my stuff was better.  LOL, I puffed out on that one for awhile, I was shooting for all bases covered.

https://community.breastcancer.org/forum/44/topic/754935?page=1

What an education! As you look back, what area was most satisfying? You have so much knowledge to share--so sorry some of it came from the personal bc experience, but glad you're here!

Hugs,
Binney

Binney, another thought-sounds crazy, but we all live with it daily. I always made a point of reading the directions of how to use equipment. Then went and practiced with the equipment  with the book.  The old fail safe "read the directions". Soooo many times wherever, it was how did you know that " I read the directions". Now ask me if I can use an IPhone. NO, LOL, but willing to learn if a grand kid becomes a reality.