Root-a-Toot-Toot

One of the things we all (well mostly all of us) grow up being taught is that passing gas, while natural, is kind of taboo. It's embarrassing, some consider it to be bad manners and we won't even get into how the smell of a bad toot can both clear a room and invoke hostility. If you are female, it's especially bad form-there have been many a TV episode plots based solely around the horrors of farting in front of one's significant other.

The average, everyday, healthy person produces about a half litre of gas a day and needs to pass gas around 14 times. Men seem to do it a little more and seem to care a little less. 

Most laproscopic abdominal surgeries require that the patient have their abdomens pumped up with gas. Carbon dioxide causes the abdomen to swell, which lifts the abdominal wall away from the internal organs. This gives the doctors more room to work. However after the surgery is over with, this will leave the patient with the gassiest stomach imaginable. Over time, the body will absorb some of the gas itself and will also expel it via good old fashioned tooting.

Early in the morning the day after my surgery I could feel my belly start to rumble. I was feeling incredibly bloated. For the ladies, imagine your most bloated point in your monthly cycle-the day where a baggy dress or track pants are the only thing you felt remotely comfortably in. You know how you can sometimes feel like you suddenly have a Homer Simpson gut? Well imagine looking down and you actually do-and it's all gas.

In the case of what we'll call "surgical gas", it can actually be quite painful and for some people can go on for days, weeks, even a month or so. You have strange sharp pains even in areas outside your belly, from your chest, to your shoulders to your collarbone area. It can make you feel nauseous, dizzy  and crampy. Some people have reported that the pain are so severe, they are certain they are having a heart attack. In my case it never got that bad, I think because I tried to move around as much as I could and do the breathing exercises (which to me seemed to help things get moving) as often as possible. I felt like a beached whale and was uncomfortable but not to the point of agony.

I knew that walking around would help so as soon as I was able to do it, I did as many laps of the floor as I could (taking breaks when required). I'd do a circuit, up the hall, past the nurse station and back down the other hall in a loop. The whole time I was walking I could fell my stomach tossing and turning as gas bubbles shifted. Usually after one lap, I had a feeling I could "produce" a little gas.  So I'd wander into my room and do a few extra paces. ROOT-A-TOOT-TOOT. HISSSS. KA-POW. BURRROP OP OP. POPPITY POP POP POP. 

The first few times I'm sure my face reddened as I looked around my empty room. Open farting like this went against every bit of etiquette I was raised with. "Excuse me" I said out loud. PFFFFFFFFTTTT. Another hissed its way out, almost in response. I giggled. This must be what it's like to be a 12 year old boy. Once the barrage of tooting would slow down and stop, I'd do another lap of the ward. Rinse and repeat. Every lap brought more farting, less discomfort (marginally) and more giggles. There is something liberating about medically required farting. I couldn't help it and I was SUPPOSED to do it. Whenever in my regular life would I ever get to be this way without it being bad manners and "not what a lady should do"?

Never.

For the next few days, every root-a-too-toot elicited an audible cheer from me. In my head, every one was getting me one step closer to feeling better and going home (passing gas was one of the four things I needed to have completely before I could be releases). If Charlie and Charlie Jr. were visiting and I had the urge to pass gas, I'd walk into the bathroom away from them but only after I announced matter-of-factly that I had to toot/fart/cut the cheese. 

And once in the bathroom I'd still giggle and cheer. 

Day Two-My kingdom for some ice chips

Much like when you start a new workout regime, day two (and sometimes three) after a surgery are where you feel the worst. Its normal. Your body is adjusting, the anesthesia has mostly left so sleep may not come as easily and you aren't quit as numb. You are likely on less medication so the pain shines through a little more. And in the case of kidney donation, they want you to get up and start moving around.
On day two I was awake at about 6AM. I was getting good at sensing someone about to come in my room about two minutes before it happened so I had woken myself up. I was insanely thirsty but my ice chips had become water and the water I had consumed. I was slightly nauseous-kind of like having a slight hangover and there seemed to be pains in places I had never felt before. Nothing terrible though.
A lab tech came in at little after 6AM and took two vials of blood. I believe that was to measure my creatine and probably something else (hence the two vials). They don't tell you. They don't say much of anything actually.  They then came back at 8AM and took more blood-same two vials...I found out later that this was a mistake and the nurses had put the request into the system twice by accident (and almost a third time!) At least it was just two vials!

During the surgery your breathing slows down a fair bit because of the intubation and also the co2 they pump your belly full of (it puts pressure on the diaphram).  These shallower breaths keep the little air sacs in your lungs from filling with air. These sacs can flatten and their insides stick together like a water balloon after you let the water out. In order to get air back into these sacs, you need to do special breathing exercises using a little contraption every hour for at least five minutes. It helps your lungs fully inflate and prevents things like pneumonia and lung collapse. The deep breathing also helps get the gas in your stomach moving which can be a main source of pain post op. You basically have to blow as hard as you can into a tube and inside the contraption a ball moves up based on your effort. It wasn't the most comfortable activity for my abdomen (pillow brace or not) but the worst part initially that day was that my already dry mouth became unbearably dry (which would also lead me to cough which hurt). It was so dry that when I tried to say something, I just kind of squeaked as well.

I realized to continue the exercising and also just to feel better, I need the ice chips and or some water. I had though around 7AM that I would just wait for shift change and ask for more ice then. But no one seemed to be coming in to check on me. I was  also starting to hurt as I hadn't had any pain medication since 3AM. At about 8:15AM I couldn't take it anymore and I buzzed the nurses station. I asked for some ice chips. They said no problem.  I waited. Half an hour later, still no ice chips. I didn't want to be a pain but I was so uncomfortable. I buzzed again. They seemed annoyed and said I'd get some soon. Shortly thereafter Dr W, the nephrologist came in to check on me. He wanted to see me do the breathing exercises. I attempted but apparently wasnt exhaling deeply enough for him (I was at 1000-1500 output and he wanted 2000). I tried to tell him I wanted to practice more but really needed some water and ice chips as my throat was painfully dry. He said he'd ask someone for some and left. Fifteen minutes later my nurse showed up and I asked her for ice chips. She did my vitals, said she'd get me more pain meds and ice. I think by about 9:30 I had the pain meds but still no ice.  It showed up at 10:15. I never though ice cubes could make me so happy. I teared up a little after I got them.

Surgery Night

By the time I was back in my room post surgery and had contacted Charlie, it was after 4:30. My pain was at about six or seven out of ten. I was not on a morphine pump which I had read many donors get the option of. Instead every few hours I was asked if I wanted more. That first night they were good about asking so I didn't feel like I was ever in a spot where I was in a great deal of pain.  The surgeon gave them a range of dosage they were allowed to give me and I don't think I was ever at the top...I think 2/3 of the maximum dose was where I felt comfortable. They want to make sure you don't really hurt but at the same time aren't too slowed down my the medication. I do remember trying to email a few people and literally falling asleep mid sentence, head down drooling.  I'd jerk awake a few minutes later and continue typing the email (I was still trying to notify people and Charlie was on his way to the hospital). I don't think I said anything silly other than announcing that Righty was now enjoying her role as Chief Operating Kidney (COK).

Because the anaesthesia and the morphine so "slow you down" I had to wear and oxygen mask initially and moved to the tubes that stick in your nose after that. That was uncomfortable because it always felt like I had "junk" in my nose that I couldn't get out and the tubing made my face feel greasier. I did appreciate however that oxygen is important and that they'd let me off of it as soon as I was ready to.  They did attempt once either that first night or the following morning but my levels instantly dropped to 90% which they weren't happy with so back on I went.

I had a really uncomfortable frog in my throat from the intubation tube in my throat during surgery. The recovery nurse had told me it was normal but I found it to be quite uncomfortable, probably because it seemed to exist through the morphine bubble I was in. I wasn't allowed water (in case it made me sick) so I couldn't drink it away either.  I was however allowed to eat ice chips which did help a little and at least kept my mouth moist. It seemed so dry and when you can't drink to help that, ice chips become your best friend.

I was feeling okay if I didn't have to move. By move I mean any movement of my arms, legs or torso or any kind of bed adjustment. They brought me more warm blankets for my tummy and also gave me an extra pillow to put on top of it...its a good protection thing and also is pretty comforting. They also told me to use the pillow as a brace of sorts if I had to cough. I hoped that wasn't going to happen because i was pretty sure that would be enormously uncomfortable (pillow or no pillow).

Being on a folley catheter was kind of a new experience as well.  It's an odd feeling-well you cant really feel it but you know its there. You feel a need to urinate but then suddenly you don't. And of course you have a tube running into a bag which is hung on your bed or IV pole for anyone to see. I was told I'd have to keep it in until they were satisfied with Righty's performance (which also can be affected by morphine!). To be honest though, if it meant I didn't have to get up  or move, I was happy to have it.

That first evening I was in an out of sleep a fair bit even with Charlie there. I'd be fine then I'd tell him I needed to sleep for a bit (usually 10-15 minutes) then I'd be awake for about the same time and cycle through again.  The nephrologist (Dr. W) was there a couple of times and reminded me to stay hydrated with the ice chips and not to go to fast with them. Before Charlie left I made sure he got me two cups of them :).  My only "homework" from the Doctor was to sit up and dangle my legs once before going to bed which I did.  Getting to a seated position sucked but once I was there is was heaven because i could finally scratch my back which had been driving me nuts for hours. I was too hot in the bed and it was also nice to have the cool air on my skin.

I have to say that first night I was very well attended to by my nurse and the staff on the floor-probably the best care I got that week (I was probably most like the patients they were used to that night). The nurse was friendly, helpful and attentive.  She made sure they washed off the excess iodine on my body so I wouldn't get itchy. They were quite bedazzled by my incisions as they hadn't seen that technique before (I guess there usually is an extra hold they were expecting) so I did have another two nurse come in to see my incisions to learn (Foothills is a teaching hospital).

I don;t know what time it was (my lack of glasses meant I couldn't see the clock above my bed and my phone was charging) but it was getting dark (so 10:00 pm?) and things were quiet in the hospital.  Charlie was gone for the night and the nurse were done most of their check-ins on me.  The curtain started to move and I knew someone was heading in. I was surprised to see Dr. S on his own, scrubs and all. He asked me how I was feeling and sat down in the chair-he looked tired. He told me that my recipient was doing really well and that Leftie was doing great in its new home. Apparently Leftie had kicked in right away and was a "really good looking kidney". I was very pleased to hear that (obviously) and was surprised how emotional and relieved I felt at that moment. After Dr. S left,  I fell asleep quickly, sleeping soundly through most of the night (even with the every four hour vital checks).