Sunday, November 15, 2009

Laparoscopic Assisted Vaginal Hysterectomy

Prepare to click away dear reader if you don’t want to know the ins and outs. But before you go, first let me tell you this. The next time you are a patient, remember to take as much control of your care as possible. It doesn’t mean be difficult, but rather challenge your doctors, ask for the outcome you wish to see. More often than not, they like the break in monotony. I told my plastic surgeon I didn’t want to be pumped up visit after visit to have big breasts, only then was I given a simpler option. I asked my OB surgeon if it was possible that I could avoid the six-inch incision through my belly muscles and he said he would try laparoscopy first. They prepared the OR for both options. Even the drugs that they give you can be altered. Most health-care programs are very open to customizing your treatment, you just have to speak up.

The Procedure
Approximate time: 2 hours

There are three primary ways to have a hysterectomy: through the big honking incision (total hyst), through abdomen laparoscopy or through vaginal laparoscopy. In my case, my surgeon performed a modified version of vaginal laparoscopy. After two enemas and the intake procedure, I was fitted with an IV, a mask to put me out (last I remembered of course) and then a breathing tube. They inserted a catheter after that to keep my bladder emptying and ease recovery if they went for the total hysterectomy. On the operating table they slanted my body slightly head down so that my other organs would slide up into my upper torso (lovely image, isn’t it?). They also inserted air into my belly so they could move their cameras around in there. The metal instruments they put into each incision also have a cauterizing/cutting tool to do the work. If you Google the procedure, you will see plenty of photos of just how it is done. I had to stop midway through one video but hope to return to it when I can’t actually feel the remnants of alien probes rifling around in there.

Once they took a gander they discovered that the Zoladex shots had temporarily shrunk my fibroid so they would be able to perform the less invasive procedure. The Zoladex had also closed down much of the blood flow to that area so that made the work even easier. The doc was quite pleased. He said my ovaries looked all healthy and pert (lil devils).

He did manage to take my cervix and some of my uterus out through my vagina (pried open with gleaming metal handles called retractors, ouch), but because I’ve never had children my vagina was not lax enough to handle much more so he had to essentially take apart ¾ of my uterus and extract it through an additional incision in my belly. Still, the difference between the laparoscopy and the total hysterectomy is worlds apart when it comes to recovery.

I woke up with some acute pain that the nurses got a handle on in post-op while a few beds down a man lay mewling in agony. Poor guy, that hurt more than anything. Once in my room, the nurses were frustrated because I kept forgetting to use my morphine drip and didn’t want two pills at a time. I guess, after my last surgery, I was expecting full-on agony and it just wasn’t there. I was certainly terrified going into this, but by the time they pulled the catheter out I was like, “Is that all you got?!” I suppose after contracting a staph infection during my last adventure I should be more hesitant to bang the drum but seriously. I feel pretty good. The worst pain I’ve felt so far is the hangover migraine that the morphine left behind.

My procedure started at 7:30 on Thursday and I went home noon on Friday. It's Sunday. And here I sit jabbering away at 90% Ladiectomy with two healthy ovaries and a chemically induced menopause and the sort of discomfort one suspects might be alleviated with a 12-pack of Activa yogurt. And let me tell you what you may already guess: I am so happy to be alive, flashing hot and cold, that I could just cry.

In the image above, the incisions. The bruise is from my Zoladex shot. I will tell my grandchildren this is all from my adventures in the French foreign legion.

Monday, November 9, 2009

Something Borrowed to Carry Me Through

Don't know what's left to say about being deconstructed over the course of a year. So I'm posting work from my friend Mary Logue, mystery novelist and poet extraordinaire. She always sums it up neat and clean and beautiful at the same time.


When you reach the longest day,
first day of summer and perfect,
the air clear and dry,
the wind making all the flowers

nod at you again and again,
when you reach this perfect day,
do you wonder which of all
the days you’ve lived through
was the apex of your life?

As the sun circles farther south,
do you begin to slide? Do you worry,
knowing you will never be here again?

Or do you give up and lie like a dog
happy on the swing in the porch,
your belly exposed and vulnerable
to all the days that will come?

—from Hand Work

(You can of course purchase most of Mary’s work at Amazon or request it at your local bookstore.)