On Monday, I had a laparoscopic Heller myotomy and fundoplication. It was performed at Swedish Medical Center in Englewood by Dr. Reginald Bell, Nurse Practitioner Kate Freeman, and an anesthetist whose name I very quickly forgot.
My almost eery sense of calm about the surgery continued on the day of the procedure. I think scheduling it for noon rather than 10am helped a lot. I was really relaxed and upbeat in pre-op and got to hang out with my wife and our friend Michelle–who happens to be a hospital chaplain–for at least an hour. We also had a great conversation with Deb, the nursing liaison. Michelle said this position was created for Deb, and I think it's a model which should be adopted widely: she acts as the point of contact for family members, providing patient status and helping the family navigate the hospital and recovery process. She overheard my wife calling my dad to ask him to pick up my prescription in Boulder before the pharmacy closed but after we got home (since he'd need my ID); Deb made a couple calls and got the prescription sent to the Walgreens across the street from the hospital so we didn't have to race the clock.
I would love to provide a fascinating narrative about the experience of having my torso inflated like a balloon and tools cutting my lower esophageal sphincter, relocating my stomach (I had a 3cm hiatal hernia), and wrapping it around my esophagus. (Un)fortunately, very quickly after I was wheeled into the super-bright operating room and I shifted onto the operating table, the anesthesiology drugs kicked in and my next memory is grogginess in post-op.
My "wake up, the anesthesia is wearing off" progress was counterbalanced by hydromorphone for pain relief, so I kept closing my eyes and trying to sleep in recovery. But the act of falling asleep would cause my breathing to get shallower and the pulseox would trigger a noisy desat alarm, pulling me out of sleep. This process went on for an hour or two–taking deep breaths was hard because I had new stitches in my diaphragm–until the drugs wore off enough that I was fully conscious and just in dull pain. I spent another hour or so working up to walking around the floor and drinking water, though a few sips of a protein shake proved too adventurous.
Concerned about the breathing danger posed by the opiates, I only took acetaminophen (Tylenol) for pain. I'd been expecting the pain to be both sharper and stronger; instead, it was more of a big ache. I also hadn't expected my shoulders to hurt significantly more than my abdomen (where the incisions were) or chest (where the esophageal operation took place). The shoulder pain was apparently partly from laparoscopic gas but mostly because of the diaphragm stitches. I had not previously realized the connection between shoulders and diaphragm, but I think it may explain some of my recurrent issues. I'll need to notice their relation in the future.
I had the presence of mind to pee right before the procedure. Through post-op and several hours at home I wasn't able to urinate, despite having gained 7 pounds of liquid that day. After my third bout of trying different positions on the toilet produced no results, I decided to try taking a shower, since I often reflexively open my bladder when immersed in water, even if I just peed. To my surprise, I didn't even have to turn on the water: stepping on the wet floor of the shower was enough to remind my nervous system how to let go.
The first night of sleep was a challenge. I find it difficult to fall asleep on my back, so I spend most sleep time on my side, which is a big challenge with painful shoulders. Five seconds after lying down, I could tell that my bed was not going to be conducive to sleep. I set up some thick pillows on the arm of a couch so my head could be significantly elevated and laid on my back with a pulseox on my finger. My wife curled up on the other couch and asked my oxygen levels when she'd hear me rustling around. She's so sweet.
Other than being tired, having sore shoulders, and a very raspy voice, I felt really good on Tuesday. I had wisely planned to take the rest of the week off work and set no goals for the week beyond resting, hydrating, and reading books. I spent the day sitting on the couch, reading about public discourse and drinking water and vegan protein shakes. The recommended diet progression is two weeks of liquids, two weeks of soft foods, and then careful reintroduction of more challenging items to swallow. This week I've progressed from coconut water and nutritional supplements through apple sauce, gelatin, fruit smoothies, yogurt, creamy soup (think split pea), and ice cream. I think I need to cut back on sugar content, not because it'll make me fat (that's what I'm hoping for), but because my mouth feels pretty overwhelmed. After ⅔ of a pint of vanilla coconut ice cream last night and a probiotic, my stomach was feeling pretty queasy and I woke up with some really intense heartburn and liquid stool at 5:30, so I think I'll back off on the pint-a-day-for-weight-gain plan I concocted last fall.
After leaving the hospital, the pain was never enough that I wanted to take an opiate. I took Tylenol for less than three days, and a COX-2 inhibitor took care of aches for the rest of the week. My body hurts less a week after surgery than it has many times after a week sitting at a desk. With luck, this spring will feature fewer pharmaceuticals than any season since the early autumn of 2014.
My accumulated vacation time is usually focused on travel and adventure, so since I started working professionally I haven't really spent a week just relaxing at home, except when I'm sick enough that my brain doesn't work well. Spending several days in a row casually eating, reading, thinking, and listening to music brings back a sense of what I really enjoyed in college. I should do this six-day-weekend thing more often :-) I also had a really relaxing craniosacral massage on Friday which put my perisympathetic nervous system in a state conducive to some really good sex, so hopefully my libido will recover in tandem with my GI system.
While my body feels really good (the major shoulder pain only lasted about three days and my abdomen is only mildly tender), I'm planning to work from home for the next week so I can have a high-powered blender and a fridge full of low-viscosity foods handy. (A career as a software engineer and an employer who believes in flexible working conditions have been crucial to my ability to handle this disease.) My intolerance to dairy products would've made this adventure difficult two decades ago, but I've been able to find cashew yogurt, garbanzo pesto, and soy sour cream, and coconut/tapioca cream cheese cream, adding to hummus and guacamole in my "condiments I can eat with a spoon" repertoire. Between soy, almond, hemp, macadamia, coconut, and oat, I've also got a tasty variety of liquid milk alternatives.
I occasionally walk past a bag of crunchy snacks and instinctively start to grab for a cracker or something. We loaded up on frozen fish yesterday and I'm excited about my office diet plan next week of soggy Cheerios, tuna fish, egg salad, and canned peaches. I'm not craving solid food so much as I am excited about it, as though I'll be embarking in a week on a long-planned trip to a regular vacation spot: at once familiar and novel.
Thanks to everyone who sent me well wishes and offered to help. Not bringing me food and inserting themselves into my healing process turned out to be the best assistance folks provided. My mother-in-law's delivery of soup turned out to be somewhat stressful (mostly for my wife) and not particularly helpful (since I'd already collected weeks worth of liquids).