What’s it like to have umbilical hernia repair surgery?

It’s 11 days after my surgery for umbilical hernia repair and I feel just about back to normal, though I’m still not supposed to lift anything over 20 pounds for another few weeks. In a nutshell, the surgery was a breeze; the recovery not so much, but I have no major complaints. Here’s the long story about how I got here.

I’ll spare you the narrative of my ENTIRE life since my own birth, but I know having an umbilical hernia for me at least goes all the way back to 2004, when I gave birth to our wonderful girl. I had occasionally noticed in the years post-partum that I had a small lump above my belly button. Sometimes. Usually not while lying down, but more prominent while standing. I just guessed it was one of the many ways my body has been touched by the pregnancy experience. It never bothered me.

Until Tuesday, May 1, 2012 (MAY DAY). I had a typical workout in the afternoon which included some basic abdominal crunches. I didn’t notice anything at first, but while I was driving home I was in sudden, throbbing abdominal pain which came in waves and caused me to remember childbirth and breathing exercises. At first I thought it was yet another strike of the norovirus and that I was about to vomit — but the pain stayed constant and I did not, in fact, vomit.

By the time I reached home, I felt and looked at my belly and noticed a larger protrusion than ever before above my belly button, and I knew I was destined for the emergency room. Had I thought about icing in advance, I might have saved myself that trip, but I don’t think I would have had such a fast plan to action had I not visited the ER.

alienIn the lovely Davies ER, the doctor tried to palpate to see if he could press my Sigourney Weaver lump back in (ok, maybe it wasn’t THAT big), but it was way way too tender for him to get near. I was given Dilaudid for the pain, and an ice pack over my belly. When the doctor returned a bit later to see if he could press the protrusion back in, surprise: it had already slipped back in. This made the essential difference, I believe, between having a “strangulated hernia” (a medical emergency requiring immediate surgery) and an “incarcerated hernia” (for which repair can be scheduled at leisure). Fortunately my body opted for the latter. I went home (I walked! Carefully. I felt too nauseated for a car) about two hours later.

I got to meet with the surgeon, Dr. Robert Murray, the next day. He was great, and came quickly to the point. He determined that it was a relatively small tear, that he could stitch it up instead of having to use mesh, and that there was no rush but that I was not to lift anything heavier than 20 pounds until 4-6 weeks after getting it repaired. Since I have been trying to exercise regularly, and since I LOVE holding my 50-lb 7-year-old girl, I opted for as soon as possible. Miraculously and with much aligning of stars, surgery was scheduled for the following Monday, May 7, at (the also lovely) St. Mary’s Medical Center.

I spent Friday getting a blood panel and EKG as preparation for surgery, didn’t eat anything Sunday night, and arrived at St. Mary’s at 8am on Monday morning.

There was very little waiting around — it was my first time at St. Marys and I found it pleasant overall. The rooms were private, the nurses and attendants responsive, and everything seemed efficient. By 9a my IV was in (first try — with much relief and thanks to nurse Debbie), and I was down in the prep area. I met with Dr. Murray and consulted with the anesthesiologist – who then rattled off an intriguing cocktail of complicated sounding drugs that would soon be flowing into my veins.

I was wheeled into the operating room, which was pleasantly chilly and decorated all over with blue tile, as if we were in a bathtub. On the gurney, arms out to sides, the anesthesiologist said “it will be about 10 seconds.” I looked at the clock — 9:30 — and that was that.

Suddenly, I was told to breathe in through a mask (oxygen?) and was back in the post-op room – the same room as the pre-op room. The clock said 10:30.

I was asked my name – several times through the process – was asked about pain (none at that time) and waited around being generally out of it for a bit. I looked at my belly, which was patched with gauze and a 4″x4″ plastic adhesive. I was told not to scratch my eyes. Suddenly it was 11:15. I was wheeled back up to my room, where my lovely wife Leanne was waiting for me.

That’s all it took — I eschewed Vicodin as a pain-killer since it depresses me, and favored Percocet, which I had not tried before. I was back home by 1p. The first day was fine — almost pleasant.

I felt a bit sea-sick lying down to sleep and had a disturbed rest. I kept feeling like I was biting my tongue (a ramification of pain killers?) and started to experience significant pain. I took Percocet and Zofran at least every four hours. The next day was not so great. I awoke to find my gauze pad completely bloody, and was in a lot of pain as if there were a knife in my stomach. It was hard to sit up from lying down. I felt like I really needed to roll over, then stand from being sideways. I must have had about 8 Percocet in the first day post-op and didn’t feel like it had any effect. I called the doctor about the bloody gauze – I was afraid I would never stop bleeding – and got an appointment for Thursday.

Dr. Murray changed the bandage on Thursday and assured me it was going well, but that I should remove the bandage on Saturday because I was evidently allergic to the plastic cover. He also told me I needed to be taking Ibuprofen together with the Percocet — something I was not told before. I’m not sure if doing this for the next couple of days or if just the passage of time made the pain start to ease.

It was after that that I noticed the hives all over my belly. Still not sure if this was because of the Percocet or the plastic. And my bowels hadn’t worked for – well – days, despite Colace.

Things started to get better on Saturday and I pitched the Percocet and was excited to take off the bandage, having fully forgotten about steristrips. The steristrips came off by Monday, and I used a little antibiotic and a bandaid for the next week.

The area looked bloody and spotted with rash for the first few days, but today I just have a slightly swollen red line around the rim of my navel where the surgeon inserted the tiny tools. I don’t see any trace of infection, which I had been worried about.

The really unpleasant part of post-op included my bowels, as a side-effect of the pain medication. I had never had such pain getting started again … The Colace seemed to do nothing. I tried some laxatives upon the advice of my mom, which worked fine — a couple days later. It seemed to take my body awhile to react to these medications. If I were to do this over again, I would have asked if I could have started the stool-softener process in advance of surgery.

Which brings us today, 11 days post-op. I probably won’t wear a bandaid by tomorrow and I only feel the smallest bit of a twinge — a little tiny pinch, really — on my navel. One disconcerting thing is a bit of swelling and hardness around my whole navel, almost as if I still have a hernia and in fact as if it has grown. I gather this is normal post-op and is a sort of swelling and healing that will eventually subside. I have a checkup with the surgeon in 10 days and after that I’m expecting the go-or-no-go for lifting and carrying things and generally exercising back to normal again.

So my key recommendations for you, dear readers, are these:

  1. Feeling a hernia? Try ice first. But of course, also go to the emergency room if you need to.
  2. Talk in advance with your surgeon about pain medications. Be clear not only on what you want, if you have a preference, but how to use it and with what other medications.
  3. Ask in advance what to expect from the bandaging — bleeding OK?
  4. Plan for constipation: is it OK to take stool softeners in advance? I don’t know the answer…
  5. Uber is a great way to get to and from your surgeries. Costs a bit more, but worth it.
  6. Have amazing friends lined up to drive and deliver things (Leanne, Liz, Rob, David… hugs).

Things really went well as a whole, and I’m looking forward to being stronger than ever in a few weeks when I can start exercising again. Thanks for witnessing this part of my life story and I hope it brings some comfort if you are facing the same experience.

Update — May 2013:  I’ve been amazed and gratified at the dozens and dozens of comments here and the generosity of sharing of experiences. It’s now a year post-surgery, and I’m as strong as ever if not stronger.

Update — September 2014: Still going strong.  Thanks all for sharing your own experiences in the comments!

 

 

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sickness and knots

knots
sickness and knots

by the time i got home thursday night, i had a fever of 101, sore throat, body aches, chills … the whole drill. i’ve been in a hot bath or asleep since then, and leanne is once again making me nice foods. this is the longest i’ve been vertical since thursday. we didn’t get to go to vegas for nate’s birthday and i’m sad for that, but i wouldn’t have been much fun. as it is, i feel a bit on the mend, though it’s quite possible nate and a martini in his honor would have sped it along.

i have noticed just today that my medial incision, previously un-scabbed, now quite possibly shows knots surfacing. i quote from dr. grissom:


Internal sutures are most commonly used to close the incision. They dissolve after 6 to 12 weeks. Occasionally the knot, which is tied to prevent the suture from unraveling, will come to the surface of the incision and cause drainage, redness, and irritation. This usually happens several weeks after surgery. If this occurs, please call the office and come in to have it removed. This is not painful and takes just a few seconds.

it is in fact six weeks since the surgery, so the timing is right for the dissolving (or the floating to the top?). i’ll call on monday if it looks the same. the knots, the sickness, and the SARS are all presumed unrelated! going to lie down again…

money

money

a stunning parade of bills for my biopsy has been arriving, and i’m not entirely sure when it will end. i’m lucky to have insurance. with over ten thousand dollars billed already to insurance, and most of it covered save for a few hundred dollars, i don’t know what i would have done had i been one of the many many many poor without insurance. here’s a sampling of my halfday of services:

  682.00 -- radiologist, including localization surgery 
                and mammography
  560.00 -- anesthetist
7,663.45 -- hospital, over a thousand of which is for 
                drugs alone
2,100.00 -- surgeon
  734.00 -- pathologist

since it turns out my old car costs $500 for its old-car tuneup today (always worth it to visit the good folks at pat’s garage), it’s a lucky thing there is 10K less that i have to owe.

blood

blood

two of my scabs fell of in the last few days. does that mean i’m healing or scarring?

blood is an interesting thing. do an idle search on google for “blood, scabbing, and healing” and you’ll find a lot about tattooing, PC game cheats, some about tainted blood and platelets, and less about what a scab might actually be good for. there’s hardly a thing you can look at on the news, or in the ‘real world’, these days that doesn’t have as its basis — and its manifestation — blood or its products, yet i hardly comprehend what it’s actually made of and what it does, much less what to do about scabs and scars. my friend todd and my late friend david were forever changed by bad blood products from bayer, baxter, and alpha pharmaceuticals. deb suffers from an entirely opposite condition of the blood, and many of us rely on products that affect the blood – but ironically might damage it – to keep us alive. two years ago you couldn’t turn on the news without hearing about mounds of burning animals, killed in masses because of the ‘mad cow’ disease risk. the phrase of today is once again ‘no blood for oil’.

if scabbing means bleeding has stopped, what does the end of scabbing mean? there is only a tiny scab left on the left corner of my medial incision. i haven’t even been picking at the scabs, because i understand that could make scabbing worse — though i don’t know why. when i lie on my stomach, one of my favorite ways to sleep, my breast hurts; when people hug me these days, i often wince. sometimes, even if it doesn’t hurt or they didn’t hit the sensitive left breast, i shout out ‘ow’, but nobody thinks its funny.

i suspect all the scabbing will be gone soon, and then i’ll see the full potential of the scars — marks of being stabbed, however precisely and on purpose, and then prevented from bleeding. then i just have to figure out how to heal.

missing

missing

it’s now just over three weeks since the biopsy, and my breast has been sore for the past few days. it’s not the incisions that are aching – those are drying up though generally look the same as they did a week ago, and the bruise, though fading, is still there. it’s more like the flesh that was removed is filled with a dull ache in its absence. leanne says she misses the pieces that are missing.

what’s it like to have needle localization and surgical biopsy?

what’s it like to have needle localization and surgical biopsy?
leanne’s observations

Starting at 10am on Friday, February 21, just before we left to go to the hospital, our dear friend Michael Hackett arrived bearing tulips and chocolates and music and movies (Foxes starring young Jodie Foster and Bar Girls, which is just the distraction needed when healing from surgery!).

We arrived at CPMC at 10:30am and parked in the parking garage which had an entrance right to Floor 2 where the breast center is (maybe this is too many details? I took copious notes!)

registration
Moya registered on the 1st floor then went to the 3rd floor where she was assigned to room 384 and promptly instructed to strip and clothe herself in a flimsy gown and sock-slippers with non-slip bottoms. We take pictures of Moya in said flimsy gown (perhaps we’ll post a photo album later!) and Moya inquires, “how’s my hair?” (it’s gorgeous). She wore one of her new sports bras to the hospital — it doesn’t fit super well. We have had a difficult time finding sports bras to fit Moya since she has a small chest size and a large cup size. Almost all sports bras for “larger-breasted women” only go up to cup size DD or DDD … or they expect you to have a large chest if you have large breasts. There’s a market space that is practically empty — sports bras for sizes like 34FF.

waiting
We were sitting and waiting for further instruction when Ali called to see how we were doing. Ali, the rock star gal that she is, was in Houston on her way to Belize for scuba diving and will be in San Francisco briefly on Thursday and Friday. We miss Ali (she moved to NYC a couple years ago and lives in Brooklyn now with her sweetie Elise). While on the phone with Ali, a nurse arrived at 11am and accidentally whacked me on the head with her clipboard — turns out I was sitting too close to the curtain (“closed door” says the nurse). Oy!

IV trouble
Moya’s blood pressure was taken (104/78 – “perfect” says the nurse). Nurse goes away to get something and Moya takes a look at her chart (whoops, we learn later after being chastened that we aren’t supposed to read her chart — liability and all). Nurse starts the process of inserting IV needle and Moya’s calm and doesn’t feel the needle but starts getting lightheaded. So she lies down. She gets clammy and the nurse wraps her up in blankets and fetches some valium and says “You’re diaphoretic” — that’s our new word for the day. Moya looks really miserable — having gone into a bit of shock from the needle. Nurse removes that IV (from Moya’s left hand) since it didn’t get in a vein, and tries to put an IV in the other hand. She can’t find a vein, the needle is just under Moya’s skin, her skin bubbles up as the fluids from the IV bag go in. Nurse removes it and says she’ll let the anesthesiologist get the IV needle in. Now Moya has bandages on both hands and a swollen area around one of the bandages (that finally went away by the next day).

bad bedside manner nearby (not for us!)
The woman sharing the room is being yelled at by her doctor because she didn’t stop drinking water at the right time. The doctor is reasonably upset that she didn’t follow the pre-surgery rules but his attitude and behavior are lousy. I’m glad he’s not Moya’s doctor.

the worst is almost over
By this time I’m feeling a bit helpless — Moya’s been in shock, stuck unsuccessfully in both hands with needles, had some valium, and she hasn’t even had the needle localization yet!

That was the worst part — it all gets better from here.

off to needle localization
11:30am arrives with Sofia the CRT who talks with us about what will happen during the needle localization and says they’ll do the lateral “easy” needle first (underneath and to the left of the nipple) and see how Moya does and then do the more difficult medial needle. I inquire about whether or not Moya wants to listen to music on my MP3 player (no, she doesn’t, she wants to be alert!) and Sofia looks at me quizzically — I explain “MP3 player.”

Sofia thinks she knows Moya but isn’t sure where they’ve met before (I love San Francisco). She explains that the 2 spots are far apart (where the calcifications are) and that she’ll take mammogram pictures and there will be a hole that Sofia will mark and then the doctor will put some Novocain there and insert the needle, some blue dye and the wire. We ask if I can come along and Sofia says of course. Wow! I’ve never seen a mammogram before and didn’t realize they’d let me be in the room while they did the mammograms and inserted the needles. I think it gave Moya some extra comfort and distraction.

Take the wheelchair! I recommend to Moya. Sofia brings a wheelchair and Moya wraps herself up in blankets and curls up in the chair. We go from the same-day surgery area on floor 3 to the breast health center on floor 2.

mammogram, needles, mammogram, repeat
By now it’s Noon and we’re in a mammogram room with a chair for Moya to sit in facing a window that looks out on California St. Not a fantastic view but better than a view of an alley or another building. And the fresh air from the open window feels good.

Nadine, the director of the breast health center checks in to see how Moya is and introduces a volunteer who is there to hang out and keep us company and help Moya from fainting from the needles. Dr Susan Denny comes in to say hi and “I’m the one who got you into this mess” (she read Moya’s last mammogram and recommended biopsy). We adore Dr Denny.

So it’s a needle localization party — Sofia, volunteer, Nadine, Dr Denny, Moya, me, and, later, Aida!

The volunteer holds some ice on Moya’s forehead and neck. Moya looks out the window. They take mammograms, develop them, examine, mark Moya’s breast with a blue pen, and Moya sits calmly with her breast smashed in the machine. She says it doesn’t hurt ( the volunteer says it really hurts but she has small breasts so what does she know about Moya’s experience anyways).

I’m fascinated and I’m so glad Moya’s not bothered by the needles going into her breast. Dr Denny puts in the first needle (lateral) and then they mammogram to see if the needle is in the right place. Then she inserts blue dye and the wire. Then they all talk about how to get the medial needle in — since the spot is above and to the right of Moya’s left breast, it’s hard to mammography (is that a verb?)

A little clear plastic cup is taped over the lateral needle and wire to protect it while they wedge Moya’s breast into another position to put in the medial needle.

is that really my breast?
There’s a lot of “wait, don’t move, relax” while Moya’s breast is wedged in between a plastic piece (with a rectangular hole in it) and a sheet of metal. It’s something like mammogram, mark, needle, mammogram, do over.

We took a lot of pictures of the mammograms (Moya says she didn’t realize her breasts were so large before she saw them in photos!) and the needles and wires because we didn’t know what a needle localization would look like before this happened … so we’ll post the pictures sometime soon with warnings on the links about what they are.

no time for waiting
By 1:05pm I’m caffeine-deprived and hungry and hadn’t realized we’d been at the hospital for 2 1/2 hours because it’s so incredibly neat that they let me watch the mammogramming and needle poking.

By 1:30pm both needles are in and it’s time for surgery. We’d been warned by the doctors and by friends that there would be a lot of waiting around. So I packed a carryon bag for the flight. Oh, well, it felt like I’d packed for a flight (lots of waiting). I had MP3 player with fabulous playlist queued up, 3 magazines (literary, semi-trashy, very trashy), a book of short stories, and my treo gadget with web access and games in case I was really feeling antsy. But, as you can tell, we were busy busy busy from 10:30am til 1:30pm with needles and shock and more needles and mammograms and more needles!

off to surgery
Jerry had a bed for Moya and he pushed her into the elevator and brought her down to surgery on Floor 1. I followed her down and kissed her goodbye before she went through the double doors. She still didn’t have an IV — turns out that the anesthesiologist got it in on the first try with no trouble. I was feeling so bad for her that she had been poked so many times already.

1:45pm: Up to floor 3 to the same-day surgery waiting room where I found her parents (Norma and Richard) and rediscovered my hunger and caffeine deprivation. We whisked ourselves up the street to Peets Coffee and flowers at Bryants and then to A.G. Ferrari for a sandwich and Pelligrino and back to the waiting room to wait for Moya to come back from the O.R.

2:35pm: Dr Nima Grissom (Moya’s surgeon) called to report that everything went fine, the tissue removed was x-rayed to confirm it was calcifications and … “just in case Moya doesn’t remember, I told her that pathology’s running a bit late so I’ll call on Tuesday to let her know if the results are or aren’t available” — what a fabulous doctor!

moya’s rockstar recovery (and amnesia)
By 2:45pm Moya was sailing by the waiting area with her thumbs-up in the air looking as though she’d just had a facial and a massage instead of a biopsy. We followed her into her room where she teased the guy who was pushing the bed and asked for a back massage. She was very chatty but she’s already forgotten being pushed in the bed and getting out and into the chair. She started dictating to me as follows … she wanted to remember everything:

  • after being wheeled through the double-doors to surgery, she was rolled into a sort of holding-area room. a pretty plain room.
  • someone named Pilar in a red, white and blue cap came in
  • she was given a little blue ‘shower-cap’-like hat to wear
  • the anesthesiologist, Dr Michael McGehee, arrived and met with her on any potential health issues (“do you smoke? anything?”)
  • dr grissom was there briefly as well
  • she was wheeled into surgery, where she was a little surprised that she had to get up and get onto the surgical table all on her own (once they wheel you around, you can actually get up and move?)
  • the surgical table was narrow and otherwise not unlike a massage table – she might have asked if she was getting a massage again
  • two huge silver circles hung over her – the lights
  • dr grissom was there and asked if she got her phone message. moya thinks she tried to say something entertaining.
  • moya gave her the cellphone number to call with pathology results.
  • dr mcgeehee had no trouble inserting the IV — pop, and it was in
  • a clip went onto her right index finger, to monitor her oxygen
  • dr mcgeehee explained all about the automated blood pressure thing as he put it on
  • he also put an oxygen thing at her nose — a plastic tube that wrapped under her nose, with two little pipes into the nostrils. pleasant air came through it.
  • two other people were fussing around on the edges and moya tried to meet them and get their names, but they seemed busy
  • her left arm was spread-eagled onto the left-arm-platform
  • moya looked at the clock – 1:45
  • having successfully established the IV, dr mcgeehee dripped something into it, then told her there was “a little versed going in” and she felt coldness going up her arm
  • she remembers dr mcgeehee saying something like ‘it’s actually not cold – it’s room temperature. it just feels cold because your body temperature is warmer’ — or maybe she made that up. that’s the last she remembers.
  • dr mcgeehee said ‘moya you can wake up’ – and apparently he had shaken her to wake her up.
  • she looked at the clock; it was 2:30
  • they wheeled outside the surgery room, and dr mcgeehee talked to her for a little bit. all she remembers is that he said “you might not remember this conversation.”
  • she didn’t realize there was an elevator ride and doesn’t remember it (surgery on 1, recovery on 3)
  • she was very pleased to see juice and water and crackers in her room but she really wants to eat sushi.
  • she said she had the best sleep ever and felt refreshed when she woke up!

instructions instructions instructions
The nurse (Blossom) says she’ll get Moya a prescription for Darvocet — that it probably won’t hurt like the dickens but it will be sore and then she gave me some instructions for Moya since “Moya probably won’t remember this later if I tell her” (the M.A.C. has an amnesiac side effect):

  • no pushups or sit-ups or strenuous exercise for 2 weeks
  • the steristrips on the incisions (under the dressing) need to stay on for 10 days.
  • no showers or baths for 2 days after surgery
  • on Sunday (after 2 days), take off dressing and leave the steri-strip tape across the incision. Soap up hands and clean/rinse over the steri-strips but don’t shower directly on the incisions (it’ll hurt). Pat dry and leave steristrips as they are — exposed to air — to help scab and heal.
  • after 10 days, peel off the steri-strips in the shower — get them really really wet and then peel off. Don’t peel off dry because skin/scab will peel off (ew!)
  • if it feels uncomfortable (now) take Darvocet — don’t wait until it’s really painful because the Darvocet will take 1/2 hour to kick in
  • call Dr Grissom next week to make followup appointment for 10 days after surgery
  • wear bra for support — it’s better not to let breast move around — keep it supported

Around 3:45pm we all left to bring Moya home — she went with her parents and I went to Walgreens to pick up her pain medication.

back home!
Moya’s an excellent patient and she’s healing super well. She’s also taking the pain meds every 4 hours so she doesn’t feel any pain (preventative medicine!) and she’s very disciplined with icing the incisions every 1/2 hour. I’ve been cooking up roasted squash and garlic, sauteed mushrooms in wine and butter, and smoky eggplant ‘bharta’ (indian dish).

She’s sleeping okay though it’s hard to find the right position to lie in to avoid putting pressure on the incisions. I woke up every few hours to look at her and make sure she was okay. Given all of the prep talks we had with doctors and friends about possible pain and discomfort, she’s doing extremely well.

good friends and shopping and food
We have a stack of rented movies and kitchen full of food and an amazing amount of support and help offered from friends. Wow!

We went out for brunch this morning with Moya’s parents and then to Dema and Home Remedies in the Mission for browsing before Moya got tired and we went home for a nap.

Sylvia and Karin brought vegetarian borscht (which I ate and liked even though I don’t generally like beets!) and we shared it with David and Kathy who dropped by for the evening.

And tomorrow maybe a little walk around the neighborhood or Crissy Field and plenty of lounging about and napping.

more later …
We’ll have pathology results sometime during the week and will send out an update. Thanks for all the good wishes!