I Want To “Feel” Brave

With emergency surgery, I was really limited in the amount of fear I had going through with a hysterectomy. Things happened quickly and I didn’t have to put a surgery date on my calendar. I went in to emergency one night to assess the problems I was having and came out 5 days later minus one uterus! I can’t imagine how it must feel to have a ‘countdown’ to surgery! Here’s one women’s feelings leading up to her surgery.

Finding Hope In Change

I want to feel brave. People keep saying that I am and I don’t agree.

The truth is that have made the decision to have a prophylactic hysterectomy (as well as my previous prophylactic mastectomies) based on fear. Fear of cancer, chemotherapy and death.

Fear is a powerful feeling and I think, if used in the right way, it can create bravery. I also think that fear can cause one to be cowardly. I DO NOT FEEL COWARDLY. I just don’t feel “Brave” either.

I have to admit that I am scared to have this surgery but, more importantly, I am scared to not have this surgery and, later, get cancer. I saw my Mom go through (and survive) breast cancer. It was awful to see the effects of her treatment: chemo, radiation, stem cell transplant. AWFUL! I’m letting that memory drive me through my prevention efforts.

With that said, the thought of having surgery…

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Pre-Op Revelations

Finding Hope In Change

I thought this blog post was going to be quick and easy but the Pre-Op appointment(s) revealed information that requires a longer entry today.

First of all I should share that I have a lovely sinus infection. Woo! It started a few days ago but I decided to avoid meds (outside of my nightly Zyrtec) because of the upcoming surgery. I was feeling better than I ever had with a sinus infection – I’d even go so far as to call it a “mild sinus infection” if there is such a thing. Well…this morning I felt like it was trying to creep into my chest so I got permission from Dr. G’s office (the on-call doctor) to get antibiotics from my general practitioner. The GP didn’t want to give me the quick and easy Z-pack because this sinus infection has been lingering since November so I’m on a 10 day…

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Why does race affect surgery procedures?

 
I found this article interesting.  It discusses how race seems to be a factor in type of hysterectomy surgery performed.  These numbers are American so I would be interested to know if such statistics would be true elsewhere.

Race, ethnicity influence chances of minimally invasive hysterectomy

By: MICHELE G. SULLIVAN, Internal Medicine News Digital Network

NATIONAL HARBOR, MD. – Race and ethnicity still appear to play a role in determining which patients receive a minimally invasive hysterectomy, and which undergo a traditional abdominal procedure.

Black, Hispanic, and Asian women were up to 50% less likely to have either a laparoscopic or vaginal hysterectomy, compared with whites, Dr. Katharine Esselen reported at the AAGL global congress.

The findings remained statistically significant even after Dr. Esselen and her colleagues controlled for a variety of patient, financial, and hospital characteristics.

“Racial disparities exist in the mode of hysterectomy in endometrial and cervical cancer, and must be further investigated to better understand the contributing factors so that they may be eradicated,” said Dr. Esselen, a clinical fellow in gynecologic oncology at Brigham and Women’s Hospital, Boston.

The researchers extracted their data from the 2009 National Inpatient Sample. It included 1,000 hospitals and more than 8 million patient stays – representing 20% of the discharges in the country for that year.

In 2009, there were 64,410 hysterectomies performed for gynecologic malignancy. More than half (54%) were for endometrial cancer, followed by cervical cancer (23%), and ovarian cancer (19%). Other cancers made up the remainder.

The majority of surgeries in all these categories were abdominal: 72% of the endometrial cases, 56% of the cervical cases, and 95% of the ovarian cases. Laparoscopic hysterectomy was the surgical mode in 26% of endometrial cases, 23% of cervical cases, and 4% of ovarian cases. Vaginal hysterectomies were performed for 2% of endometrial cases, 21% of vaginal cases, and just 1% of ovarian cases.

A multivariate regression analysis controlled for demographic factors (age, race/ethnicity, insurance); patient factors (cancer diagnosis, fibroids, endometriosis, prolapse, menstrual disorders, age, severity of comorbidities, obesity); and hospital factors (urban/rural, teaching status, size, and region of country).

After adjustment for all of these factors, black women were 43% less likely to have a minimally invasive hysterectomy for endometrial cancer than were white women – a significant difference. Hispanic and Asian women were also significantly less likely to have minimally invasive surgery (MIS), with odds ratios of 0.61 and 0.63, respectively. Native American women, however, were more than five times as likely to have such a procedure compared with white women (OR, 5.26).

Insurance also played a role, Dr. Esselen said. Those with Medicaid were significantly less likely to have a minimally invasive procedure (OR, 0.64) than were those with private insurance.

The findings were similar for ovarian cancer. Black and Asian women were significantly less likely to have MIS than were whites (OR, 0.41 and 0.44, respectively). There was no significant difference seen for Hispanic women.

Medical comorbidities were significantly related to the chance of MIS as well. MIS was significantly less likely in women with moderate loss of function due to comorbid conditions (endometrial OR, 0.47; cervical OR, 0.62; ovarian OR, 0.38). Those with major to extreme loss of function had an even smaller chance (endometrial OR, 0.23; cervical OR, 0.21; ovarian OR, 0.10). The P values on these were all less than .0001.

Obesity only affected MIS odds in endometrial cancer, significantly increasing the chance of such a procedure (OR, 1.27).

Types of Hysterectomy Surgeries

ImageThere are several types of hysterectomy surgeries that can be performed and they all have certain benefits as well as challenges/risks.

Abdominal hysterectomy:  As the name suggests, this surgery involves an incision in your abdomen, often 5-7 inches long.  It may be vertical or horizontal depending on a number of factors.  The recovery time for this type of surgery tends to be the longest out of all of the options.

Vaginal hysterectomy:  The surgeon will make a cut in the vagina and remove your uterus that way.

Laparoscopically-assisted vaginal hysterectomy:  The uterus is still removed through a cut in the vagina but the surgeon will use a laparoscope to assist in this process.  It involves 3-4 small abdominal incisions in order to insert the laparoscope.  The recovery time tends to be shorter with this type of surgery.  This is the procedure I had.

Robotic-assisted hysterectomy:  This is also referred to as the DaVinci method.  It utilizes a small robotic machine that works through small incisions similar to laparoscopic surgery.

There are numerous factors that impact which of these surgeries is best for any given patient including weight, recovery time, and the reason for the hysterectomy.  I will post more about the benefits and challenges of some of these surgeries in a future post.

Types of Hysterectomy

This appears to be one of the most misunderstood aspects of hysterectomy.  I was not clear on this either, before I had a hysterectomy.  I found people would hear about my surgery and then would label it with terms that they were familiar with but did not accurately describe my surgery.  Here are the three types of hysterectomy surgeries as found on the Mayo Clinic Site:Image

Supra-cervical hysterectomy (also referred to as a partial or subtotal hysterectomy): This is the removal of the upper part of the uterus only and leaves the cervix in place (first image pictured above).

Total hysterectomy:  This involves the removal of the uterus and cervix and is the procedure I had (bottom left image).  However, if I told people I had a total hysterectomy they assumed that meant the removal of ‘everything’ which is actually a:

Radical hysterectomy: involve removal of the uterus, cervix, fallopian tubes and ovaries (far right image).  This occurs most often when cancer is present.

To add to the confusion, these are types of hysterectomy based on what is removed.  Types of hysterectomy can also be classified based on the type of surgery performed.  More on that in the next post!

Hysterectomy – The Basics

Here is a great summary of the general information that is helpful when considering a hysterectomy.  Over the next several weeks, I hope to break down this information in even more detail. For example, what are the reasons for a hysterectomy and what are the main risk factors.  Check in during this time to get more information on the topics mentioned here.Image

Hysterectomy

Description

During a hysterectomy, the surgeon may remove the entire uterus or just part of it. The fallopian tubes and ovaries may also be removed.

Types of hysterectomy:

  • Partial (supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
  • Total hysterectomy: The entire uterus and cervix are removed.
  • Radical hysterectomy: The uterus, cervix upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.

Your doctor will help you decide which type of hysterectomy is best for you. The choice often depends on your medical history and reason for the surgery.

Why the Procedure is Performed

There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:

Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor or nurse about all your treatment options. Less invasive procedures include:

Risks

Risks of any surgery are:

Risks of a hysterectomy are:

  • Injury to the bladder or ureters
  • Pain during sexual intercourse
  • Early menopause if the ovaries are removed
  • Decreased interest in sex
  • Increased risk of heart disease if the ovaries are removed before menopause

Ask your doctor if taking estrogen can help lower the risk of heart disease and help menopause symptoms.

Before the Procedure

Before deciding to have a hysterectomy, ask your doctor or nurse what to expect after the procedure. Many women who have had a hysterectomy notice changes in their body and in how they feel about themselves. Talk with your doctor, nurse, family, and friends about these possible changes before you have surgery.

Tell your health care team about all the medicines you are taking. These include herbs, supplements, and other medicines you bought without a prescription.

During the days before the surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
  • Ask your doctor which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop. Ask your doctor or nurse for help quitting.

On the day of your surgery:

  • You will usually be asked not to drink or eat anything for 8 hours before the surgery.
  • Take any medicines your doctor told you to take with a small sip of water.
  • Arrive at the hospital on time.

After the Procedure

After surgery, you will be given pain medicines to relieve any discomfort.

You may also have a tube, called a catheter, inserted into your bladder to pass urine. The catheter will likely be removed before you go home.

You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds recovery.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea or vomiting.

How long you stay in the hospital depends on the type of hysterectomy.

  • You can likely go home the next day when surgery is done through the vagina using a laparoscope or after robotic surgery.
  • When a larger surgical cut (incision) in the abdomen is made, you may need to stay in the hospital 1 to 2 days. You may need to stay longer if the hysterectomy is done because of cancer.

Outlook (Prognosis)

How long it takes you to recover depends on the type of hysterectomy. Average recovery times are:

  • Abdominal hysterectomy: 4 to 6 weeks
  • Vaginal hysterectomy: 3 to 4 weeks
  • Robot-assisted or total laparoscopic hysterectomy: 2 to 4 weeks

A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy. Discuss with your doctor the risks and benefits of this therapy.

If the hysterectomy was done for cancer, you may need further treatment.

Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/002915.htm

What you can expect – anesthetic (article from Mayo Clinic)

Image

There are lots of things that you learn about when you decide to go in for a hysterectomy.  Unfortunately, some of these things are only learned after we actually went through the surgery.  For me, one of those things was about anesthetic.  I had ‘been under’ twice before – once for removal of tonsils and once for removal of wisdom teeth – wow, doctors apparently really like taking things out of my body!).  I knew I always woke up very nauseated and both previous times I threw up in short order – something I really wanted to avoid right after a hysterectomy!  Well, apparently, it was not the anesthetic but the codeine that made me sick.  I had no codeine this time and woke up feeling pretty good.  However, what I did have was a sore throat and no idea why.  This post from the Mayo Clinic explains why.  It was from the tube they inserted in my throat while I was under.  It was fairly minor overall, but just one of those things that I didn’t learn until after it actually happened.  Hopefully this post will help you be a little more prepared for these effects than I was!

From the Mayo Clinic: http://www.mayoclinic.com/health/anesthesia/MY00100/DSECTION=what-you-can-expect

Before general anesthesia
Before you undergo general anesthesia, your anesthesiologist will talk with you and may ask questions about:

  • Your health history
  • Your prescription medications, over-the-counter medications and herbal supplements
  • Allergies
  • Your past experiences with anesthesia

The information you provide will help your anesthesiologist choose the medications that will be most appropriate and safe for you.

During general anesthesia
In most cases, your anesthesiologist delivers the anesthesia medications through an intravenous line in your arm, but sometimes the anesthesia may be given as a gas that you breathe from a mask. For example, children may prefer to go to sleep with a mask.

Once you’re asleep, a tube may be inserted into your mouth and down your windpipe to ensure you get enough oxygen and to protect your lungs from blood or body secretions, such as from your stomach. You’ll be given muscle relaxants before doctors insert the tube, to relax the muscles in your windpipe. In some cases this breathing tube isn’t needed, which reduces your chance of a sore throat after surgery.

Your doctor may use other options, such as a laryngeal airway mask, to help manage your breathing during surgery.

A member of the anesthesia care team monitors you continuously during your procedure, adjusting your medications, breathing, temperature, fluids and blood pressure as needed. Any abnormalities that occur during the surgery are corrected by administering additional medications, fluids and, sometimes, blood transfusions.

Blood transfusions may be necessary in some situations, such as complex surgeries. Anesthesiologists and other members of the anesthesia care team monitor your condition and deliver blood transfusions when necessary. However, blood transfusions may involve risks, particularly in people who are older, who have low blood red cell volume or who are undergoing complex heart surgeries.

After general anesthesia
When the surgery is complete, the anesthesia medications are discontinued, and you gradually awaken either in the operating room or the recovery room. You’ll probably feel groggy and a little confused when you first awaken. You may experience common side effects such as:

  • Nausea
  • Vomiting
  • Dry mouth
  • Sore throat
  • Shivering
  • Sleepiness
  • Mild hoarseness

You may also experience other side effects after you awaken from anesthesia, such as pain. Side effects depend on your individual condition and the type of surgery. Your doctor may give you medications after your procedure to reduce pain and nausea.