Ah, post-operative recovery, sloshing is thy name.
Last year’s surgery, a colonic resectioning, left me with a nearly foot long abdominal incision running vertically from my belly button to my pubic bone. In order to reach my colon, the surgical team had removed or otherwise relocated many other organs. This meant that the two overriding physical sensations of post-operative recovery were the muscle issues of having a completely severed abdominal wall, and the general weirdness of having my internal integuments reknitting their usual connections.
This year’s surgery was a thoracotomy. I quote Wikipedia, “Thoracotomies are thought to be one of the hardest surgical incisions to deal with post-op, because they are extremely painful and the pain can prevent the patient from breathing effectively.” As my thoracic surgeon said, the insult to the body is an order of magnitude less severe than last year’s surgery, but the pain scale is comparable.
As a result, I expected this recovery to be physically easier, characterized by pain management rather than the severe mobility and functional impairments of last year’s. This has been true, up to a point. I’ve been rocking the Dilaudid, though I cut my dosage by a third yesterday without dramatic ill effect, which has done wonders for my mental acuity. And as my adventures in walking have testified, my mobility has been strong. I’ve been limited largely by my lung functionality, which seems to be making a rapid comeback.
The overriding physical sensation, however, has been one of extreme discomfort with respect to swelling in and around the surgical site.
After the operation, I had a chest drain in, from Wednesday 11/25 through Saturday 11/28.
© 2009 Shannon Page
The drain was profoundly uncomfortable — over a foot of tubing big around as my thumb looped inside my chest. (Its removal is a tale for another time.) But it did something important. My first day out of the O/R, my body put out almost 500 ml of fluids. They wouldn’t remove the drain until I was putting out < 100 ml per day.
So Saturday the tube came out. Very strange, a bit difficult, over swiftly. And the fluid buildup began.
By Sunday, I felt as if someone had duct-taped a grapefruit to my left chest. I couldn't hang my left arm straight down. The actual appearance of the swelling was far less dramatic, as
What we’ve worked out over time is that the fluids inside my chest are at least somewhat mobile. Which is to say, if I’m lying down for a while, they reach an equilibrium which feels very strange when I stand back up. If I’m on my feet for a while, the reverse happens. So every time I change my body orientation, the distribution of fluid changes, and I get a lot of strange sensory impressions. Proprioceptive hallucinations, as it were. Heat, cold, pressure, point-source pain, a sense of being gripped from outside — all manner of weird things. As I’ve been healing, the fluid volume has been reduced, but the body cavity has not yet reached its normal state, so these past few days the sensations have increased as the fluid has been ever more free to move around. Plus as the nerves around the surgery site continue to heal, this effect has been amplified. Icing the swelling helps, but removing the ice only seems to increase the odd sensations and false neural signalling.
This, not the pain or the wound healing, has been my single biggest impairment. Because I have what amounts to a burst bag of fluid reaching from my left shoulder blade to my left nipple, sitting in a car is difficult. The significant discomforts are associated with the swelling and the fluids sloshing about slowly within. Likewise the generalized weirdness.
Who knew? This wasn’t even on the pre-op “what to expect” list.
Tomorrow, we’re off to see the thoracic surgeon for a post-op consult, and to have some stitches removed from the drain site. Once this swelling goes down more noticeably, I’ll be a much happier camper.
© 2009 Shelly Rae Clift
This work by Shannon Page and Shelly Rae Clift is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 United States License.