Saturday, 3 February 2018

Second Pre-Assessment Appointment

Yesterday I had my second pre-assessment appointment at the hospital, in advance of my upcoming operation. This time I saw one of the anaesthetists, and I was able to go over a few points with him that I’d covered last week with the nurse.

The main thing I wanted to talk to him about was having a PICC line installed at the outset, to avoid the problems I had last time with all my cannulae failing, and me ending up like a pincushion. He wasn’t over-keen on the idea, and said they like to do the minimum of invasive procedures – in this case there is a small risk of embolism, but when I asked him how small, he said “less than 1 percent” which I said was certainly very small, and I’d be prepared to take that risk, for the sake of an easy life and peace of mind!

He said it was really up to the anaesthetist in charge on the day of the operation, and also my surgeon, and suggested I speak to them on the day. He then said that if I were to have it done, they would need extra time on admission for the procedure, to which I responded that if it was up to me to talk to them beforehand, it would already be too late – he took my point, and said he’d put it in the notes and speak to them about it himself. He said different people had different ideas about risk, so opinions varied.

He said that a year on, my veins may have recovered sufficiently by now for the cannulae to work anyway, and was I prepared to try. Reluctantly I said perhaps I would, but I would still prefer the PICC, to be sure. I told him that my neuropathy and bladder problems had not improved at all in the last year, but he said that not all effects of chemo recover at the same rate, and veins recovered more quickly than nerves, so there was a chance that I’d be fine.

I’ll just have to wait and see what they decide, and if they prefer me to try the regular cannula first, I’ll go along with that – I have at least made my preference clear, and it’s up to them now. If the first cannula does fail, then I shall definitely request a PICC, and I am sure that at that stage, they will agree, but that will be after the operation.

My hubby chipped in that each time a cannula failed, I was not getting the pain relief, sometimes for several hours, and this was most unsatisfactory.

We discussed post-operative pain relief and he said he could see from last week’s appointment that I was happy to have the rectus sheath catheters and PCA (morphine pump) that I’d had before – he said that often the rectus sheath catheters were less satisfactory than an epidural, but I said I wasn’t too keen on this, but added that this was probably because I’d never had one and didn’t know what to expect, and that I had found the rectus sheath catheters helpful. He said as long as I was happy with what I’d had before, they’d go ahead on that basis, although I may not be able to have them if my surgeon thought they would interfere with the mesh he will be inserting during my hernia repair, so again, we shall have to wait and see.

I told him that last time, after my emergency surgery, I was in a lot more pain initially, and he agreed that was to be expected, given that I was already very poorly and not as well as possible like the first time, which was elective surgery. We also agreed that this was why last year’s experience was generally very much worse than before, and why it took me so much longer to recover. He asked how long I’d been in recovery that time, but I couldn’t remember – the first time, I spent the whole night there, and went onto the ward the following morning.

I asked that they would insert the NG tube while I was under the anaesthetic, because last year it was done while I was conscious and it was truly a horrible experience. He said that they are not inserting them as a matter of course now, and it may not be necessary for me to have one at all – it depends how much my bowel will be handled. Again, my surgeon will decide, but in any event, it would be inserted under anaesthetic; the reason for it being done while I was conscious last year was that it is the standard treatment for an obstruction, which I knew, and once it was in, it did make me feel a lot better and prevented any further sickness.

He told me to stop the Rivaroxaban (anti-coagulant) two days before the operation, which is more or less what I thought.

On the subject of the ward staff being aware of the limitations imposed by my ME, I explained the unpleasant experience I had after my first operation, and that obviously my concerns had not been passed on. He said it was in my notes, but because these are extensive, not everybody might see that, and also that nurses tended to be very much procedure- and routine-driven and perhaps not so easy to convince of individual special needs, although the nurse last week said that she hated “blanket rules” and everybody should be treated as an individual! He said I should mention this concern to everybody, to make them all aware, in case they had not been told, or had not seen my notes. My hubby confirmed my low energy levels, and how I can suddenly run out of energy and need to rest. I told the anaesthetist that anyway, at home, I spend much of my time with my legs up on the recliner as this is a lot more comfortable for me and less tiring, and sitting in this position in a hospital bed is really no different. I told him that I do try to keep my feet and legs moving, and that I am normally moving around the house quite a lot, and only use the wheelchair when out and about, but after an operation it is a different matter.

We agreed that major surgery really takes it out of even normal, healthy people, and that allowances should be made when one is starting with an already low base-line. I am hoping that after this discussion, I will be given more leeway and won’t get bossed about – I told him that on that first occasion I was already feeling very vulnerable immediately after major surgery, and didn’t feel up to having to fight my corner, and it upset me that it was necessary for me to do so.

He asked what were the main symptoms of my ME and how they affected my life, and I told him that it was mainly very low energy levels, and rapid muscle fatigability, balance problems, disrupted sleep due to my internal clock being out of sync, and brainfog.

I said that before, as a matter of course, I had been given an airflow mattress and foot pumps, and was keen to have these again, and he agreed with this. Having the foot pumps should certainly help prevent DVTs especially if I am less able to spend time out of bed, particularly initially.

He also raised the subject of the coronary artery spasm I had in 2014 and asked if I suffered any angina attacks, to which I replied that they were extremely rare. He asked what brought them on, and I said in each case it had been stress! I told him that the main cause of the stress had now been removed (Mum, before she went into a care home, and how difficult it had been for me in the run-up to my first operation) and that as far as my heart was concerned, I was really pretty well. They are obviously aware of this, though, and will take it into account, along with the left bundle branch block which they are also aware of. I told him I’d been under considerable stress recently, with my hubby breaking his leg and Mum dying, and so much more being put onto me, but that things were very much better now. Thankfully none of this brought on an angina attack.

That more or less covered our discussion. Everything else had really been covered last week, but I did feel it was beneficial to discuss these matters with an anaesthetist as I had done at the pre-assessment before my first operation. I didn’t have one before the second operation, of course, because that was an emergency.

I told him that I was very impressed with how thorough they were, checking all these things in the days leading up to surgery, and how much things had improved in the twenty-odd years since my hysterectomy, when more or less all they asked was if I’d had any previous operations and did I have any allergies! I said the pain management was so much better as to be almost unrecognisable compared with that time, and he agreed that great progress has been made in these matters.

We are still waiting for a date.

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