Apologies for boring regular readers, but while prepping for this operation I couldn’t find much useful patient-oriented data on the net. So here’s my experience:
With keyhole surgery, you can have your appendix out and be reasonably functional (but unable to do serious exercise) in just 19 hours.
During those 19 hours, the biggest discomfort is caused by the the CO2 injected for the operation inflating the abdomen, pushing on the diaphragm and causing referred back pain.
Life is easier if you take painkillers to a fixed schedule.
Make sure you’re well hydrated before you hit the 6 hour no food & water limit before the operation.
Take a notepad to record your post operaive regime – medical professionals have a habit of giving you helpful advice while you’re still fuzzy.
People vary wildly, so you may have better or worse outcomes. I’m fairly fit, run about 900 hilly miles a year, have a resting pulse of 50 and blood pressure 120/70. I’ve only visited hospitals after running accidents, and only once stayed overnight (mild skull fractures). Like most long term runners, I’m accustomed to living with discomfort and heal fairly quickly. Oh, and I’m thin.
In recent years during periods of high stress I often had abdominal cramps, followed by by one or two days of sharp pain about 3 inches inboard of the top of my right hip -painful enough to stop me running. Plus a mild fever.
The past two weeks were high stress – the worst Italian real estate transaction ever, and a 10 hour deposition to some criminal trial lawyers (the lawyers were the criminals).
That triggered the symptoms again so at Mrs G’s
nagging urging I had it checked out.
We’re visiting London and pay our own medical expenses, so getting great medical services is quick and painless (except for our bank balance).
My doctor prodded the relevant area, suggested three possible causes, and recommended an Ultrasound scan.
That took about 30 minutes, the lady doctor using the probe to check the pain site from multiple angles, palpitating it to move things around, comparing it with the opposite side, then switching frequencies to go shallower and deeper. She concluded I most probably had an inflamed appendix.
This wasn’t hard. We were planning to leave the next day to oversee the refurb of our Italian house (unless you’re there, builders vanish). But my doctor said an inflamed appendix can burst any time forcing either a MedEvac or an emergency operation in a country where our language skills are weak.
After checking the data on Wikipedia, and the surgical options at the excellent NIH, I decided to go for an immediate appendectomy using laparoscopy (keyhole surgery) using a surgeon who had done the operation many times. We talked on the phone to confirm all the data and scheduled it for the next day, Tuesday.
Now things got hard. You have to completely fast for 6 hours before surgery & that meant nothing by mouth after going to bed at midnight on Monday. This was tough since I like to stay hydrated.
I checked in to the private hospital at 9:30 AM Tuesday for an 11:30 AM operation and met the surgeon, a very English black guy with pianist’s hands. He told me that, if all went well, I’d be out of the hospital the next day, and explained how he’d make 3 incisions – one for the combined minicam/extractor, and two for the manipulators.
Then I got to know the ward nurses and other specialists – it’s always interesting to learn about other people’s lives and skills. I’m guessing most are not well paid, and London’s sky-high real estate prices have forced them out into the burbs. The road taxes of London’s lefty mayor (£7 a day!) make it impossible for them to drive to work, so many have terrible commutes.
The anesthetist turned out to know our Southern Med base well, and recommended a good restaurant there.
After a 2 hour delay caused by an emergency, I stowed my glasses and watch, climbed into the hospital robe, the ward Sister helped me put on compression socks (to prevent blood clots), I climbed onto the mobile bed and (feet protruding over bed end) was whisked down to the surgical floor by a small Asian guy who expertly avoided shutting my feed in elevator doors.
The anesthetist’s assistant asked if I had any allergies and I said that he was was the seventh person to ask me that question, and that I was now forced to admit a violent allergy to anesthetists. Hollow laughter followed, the anesthetist expertly plugged his catheter into a blood vessel in my left arm, strapped it in place with an enormous amount of surgical tape and the lights went out.
Operation (1:30 – 2:00 PM)
The surgeon did his stuff.
Post Op (2:00 – 2:15 PM)
The operation took about 30 minutes (I didn’t have my watch & couldn’t read clocks without glasses) and came to in the post-operative ward, was told everything had gone fine. After a few minutes to confirm I wasn’t going to crash (rapid fall in blood pressure and pulse after anesthesia) the Asian guy wheeled me back to my room, again miraculously preserving my feet.
I had three small waterproof band-aids on my slightly swollen abdomen – one just below the navel covering the 10 millimeter port for the minicam/extractor, one about two inches lower, and one about an inch above the camera port. There was some blood residue visible beneath the the camera port dressing, but hardly any beneath the other two.
The ward sister had already called Mrs G and she was headed in.
Immediate Recovery (2:15 – 3:30 PM)
Problems, in priority order:
1. Dehydration – I’d had no fluids for 14 hours.
2. Pains in upper back muscles caused by the CO2 used to inflate the abdomen to provide access during keyhole surgery. It presses on nerve that’s connected to the shoulders (design fault).
3. Bloated abdomen (that CO2 again) and small pain from the three incisions.
4. Sore throat from anesthetic process.
5. Slight difficulty in breathing, caused by CO2 pressing up on the diaphragm.
Mrs G arrived, said I looked fine but was “uncharacteristically silent”, then went off to buy a hat and stock up with chicken soup for my return.
Crash recovery (3:30 to 6:30 PM )
I followed my running accident routine – after treating the wounds, just take painkillers and sleep for several hours.
Evening (6:30 PM to Midnight)
No appetite, but I fixed the dehydration by drinking 6 pints of water (the saline drip does this too, but I wanted to accelerate the process). We (me and nurses) were a bit concerned that nothing emerged for several hours, since abdominal operations sometimes lock up the bladder. But eventually, with the help of running the bathroom faucets, I got the process jump started.
I shuffled about 40 yards round the ward without ill effect, but found I was still quite anesthetized.
Dinner arrived – I still had had zero appetite but managed another bowl of soup and some jello.
Mrs G arrived looking very cute in her new hat and bearing grapes.
I was too spaced out to read my Michael Dibdin book, was reduced to watching Brit TV. Horrible.
An unfortunate woman in a nearby room began to retch & cry with pain. My room was close to the nurses’ desk, so I could track the progressive and rapid escalation within the nursing team, then to the duty doctor, and finally to the surgeon. It was all very British – organized, calm and helpful.
Overnight (Midnight to 9:00 AM)
The nurses provided me with two painkillers and told me to call for more at either 4 hour intervals or if the pain got too bad. But I hate taking pills I’m not familiar with, so took them singly and only asked for more when the pain was annoying.
That was a mistake since the pills take a while to kick in, and I spent the night managing seesawing discomfort.
Next Morning (9:00 to Noon)
The woman who had the problem overnight was OK.
I could only drink tea, so felt like a D Day casualty (minus of course the obligatory cigarette, now banned in all Brit public places).
The surgeon arrived and confirmed the appendix was indeed inflamed and had been tricky to remove since it had attached itself to some other structures (a Gandalf design flaw!).
He also told me an excellent lawyer joke that unfortunately the residual anesthetic prevented me remembering – the punch line is something like “you open them up and there’s no heart and no guts!”
The sore throat and dehydration had gone, and the diaphragm pressure, sensitive abdomen, and pain in upper back had diminished. I wanted to walk back to our apartment – the surgeon said walking is good after abdominal operations. But Mrs G arrived and she and the nurses thought otherwise, so we cabbed back.
This is a general feature of the medical profession – the folks at the top advise you to take risks, while the ones at the sharp end advise the opposite, possibly because they have to clean up any problems
I carefully wrote down all the advice on wound dressings, drugs, and problems to watch for, said my goodbyes to the team and headed out with Mrs G carrying my overnight bag.
Noon to Midnight
Still no appetite, but it was great to be home, shuffle about the apartment and be fussed over by Mrs. G. I had no desire for alcohol.
I took one dose of painkillers then didn’t need them.
At midnight most of the discomfort vanished, just after taking a prescribed anti-inflammatory. But I suspect this was just a healing step function.
Woke up fine after 8 hours sleep, appetite normal, no pain. Eating normally.
No need for painkillers, but taking anti-inflammatory pills as instructed.
Abdomen now much less distended (the CO2 is either absorbed or leaks into the intestine and exits in the usual way). Digestive system not yet operational (takes up to 2 days).
It’s still a bit painful to sneeze, and I’m favoring the abdominal muscles. But mental clarity (such as it is) has mostly returned, and I can walk normally (but am advised not to run).
There’s no sign of further bleeding behind the band-aids.
I’ll update if anything interesting happens – of course if there are no further posts on DU, you’ll know I’ve checked out.
One small concern is the loss of my appendix (my ellipsis):
Given the appendix’s propensity to cause death via infection, and the seeming perfect health of those who have had their appendix removed, the biological purpose of the appendix has mystified biologists for some time…
(But the) appendix is experimentally verified as being rich in infection-fighting lymphoid cells, suggesting that it might play a role in the immune system…(or) that the appendix serves as a safe haven for useful bacteria when illness flushes them from the rest of the intestines.
So without my lymphoid cells and useful bacteria, I may end up dying of bird flu.
UPDATE: 5 days after operation
Gas has all gone and my digestive system is almost back to normal. Walked 2 miles today. Some dizziness, maybe caused by anti-inflammatory pills which I’m still taking. Wounds feel as if they’re healing and no discomfort when I cough. No problem about taking showers.
UPDATE: 7 days after operation
To surgeon for post-operation check up. Everything is fine, he replaced the waterproof band aids covering the 3 incisions with a few Steri-strips (translucent wound dressings about 2″ x 0.25″) – these allow air through to speed healing. There are no stitches or staples, and I can continue to shower. OK’d to fly next day.
UPDATE: 8 days after operation
Flew back to Southern Med. Mrs G insisted on carrying all the luggage and ripped new orifices in the BAA security people at Heathrow airports who wanted me to walk shoeless on their dirty floor.
Three hour flight went fine – if any CO2 had remained, I could have blown up like a balloon, perhaps exploding, Alien style.
UPDATE: 11 days after operation
Life back to normal, although I can’t run until the wounds have healed – Mrs G (who continues to be motherly) rules that’s three weeks away.
UPDATE: 28 Days Later
Digestive system is finally working OK – not sure if problems were caused by too much travel and unusual foods, or after effects of operation. Until a few days ago I had mild dizziness after standing up for more than 30 minutes, but that’s gone away too.
I drove for the first time today, no problems.
So tomorrow I’m going for my first run in 4 weeks!
If that’s OK, I’ll rate recovery as 100% complete.
UPDATE: Final Report 33 Days After Operation
Ran 4 miles yesterday and 7 today, without incident. It was hard after missing out on 5 weeks training – muscles atrophy amazingly fast. But there were no abdominal pains and the incisions seem fine. All but three of the Steritabs have fallen off anyway.
So the appendectomy only took me out of ciculation for a few days and put a 5 week blip in my exercise routine.
I’m still having problems with the hospital’s billing – it dinged my credit card with an inflated amount while I was in surgery. So if you’re having an operation in a private Brit hospital, take someone with you to fly top cover while you’re out of action. And check if you can get a better deal in a French or US hospital.
My advice to surgeons is to try to vent the CO2 after the operation – that would save a lot of post-operative discomfort.
Still, isn’t science wonderful? Fifty years ago I’d have faced a significant chance of death, and having dodged that bullet would have been laid up for months after surgery.