TURP Procedure

August 18, 2011 12:15PM Arrive at Kaiser Permanente: Walnut Creek, CA. A nurse gives me a gown to change into, sock booties for my feet, and a hair covering. I meet with another nurse who confirms what procedure I am in for and that I have followed all of the pre-surgery instructions from the OR Education Nurse. There's an initial moment of confusion when the nurse says, "So, the surgery you are in for today is a Prostatectomy." I say,"No, I'm in for a TURP." "Same thing." "Sorry," I say, "I'm used to hearing the word 'Radical' in front of Prostatectomy". I get two new wristbands on my left arm, one clearly identifying that I have drug allergies. These are added to the bracelet I already received on August 16, to indicate my blood type and anti-bodies. A little while goes by and I get a cannula, a thin tube inserted into a vein to administer medication, on my right arm. I'm told that the estimated time I'll be in surgery is 98 minutes. Scheduled start time is 1:30PM.

Prepped for Surgery in Pre-Op

A male nurse comes by and shaves my pubic hair. Bizarre. Next, the Anesthesiologist visits me to explain what his role is. He says that I'll be receiving a spinal tap that will make the bottom half of my body warm and numb. I'll feel pressure but no pain. He asks if I have a preference on my sedation, do I want to sleep through the procedure or be in a sort of hazy state? "Sleep through it." I also tell the Anesthesiologist that I'm anxious and would like to get something to calm me down. I'll get that as we advance to the OR. I ask how painful the procedure is, and the Anesthesiologist says "Not very. You will be fitted with a catheter and you will feel like you have to pee all the time, but that is more discomfort than pain." Now, the Anesthesiology Nurse arrives to give me a few more details. First, I'll get a numbing injection in my spine that will briefly feel like a bee sting. After that takes hold, I'll get the spinal tap. I'll also be fitted with a special pair of inflatable leggings on my calves. These use an air pump to push blood through the veins, first one leg then the other, to prevent blood clots while a patient is not ambulatory after surgery. This treatment is called IPC, Intermittent Pneumatic Compression. Finally, I am visited by my surgeon. We talk a few minutes about the procedure. He explains that he is using the latest TURP instrument that cauterizes as it goes. Blood loss from the actual surgical procedure may be as little as about a teaspoon. We wait. And wait. A nurse arrives to tell us that the surgery immediately before us is taking longer than expected. Finally, I get wheeled into the OR about 3:00PM. On the way, the Anesthesiology Nurse explains that the OR looks crowded, but they have everything they need close at hand. She pats my head gently as we roll into the OR. I'm moved up parallel to the surgical station and slid over, with help, to the bed. The IPC leggings are placed on my legs. I'm told to turn over on my side. "Oh, you have a beautiful back!" the nurse says. Really, I think, with the curvature of the spine and the deteriorating lumbar region? "All the vertebrae are nicely exposed, so I can see what I'm doing. OK, you'll feel something like a bee sting." That was just the numbing agent before the spinal tap. After that, I don't remember anything at all until I woke in the Recovery Room. My angel wife, knowing the operation was only supposed to be about 90 minutes, got some lunch near the hospital and came back, expecting me to be out of surgery. This hospital has a nice feature - a video monitor for viewing a color-coded status for patients, based on an assigned secret code, telling you what stage a patient is in: Pre-op, Surgery, Recovery, etc. The closest thing I can describe this as is like the display screens at the airport, tells you the status of your flight. My wife arrives back and checks the monitor - still in Surgery. OK. Waits a while, checks again. Surgery. Repeat, repeat, repeat. Now, she's getting a little worried. Finally, she sees I'm in Recovery. Guys, one thing to remember: supporting you in this is hard on your wife/girlfriend/partner emotionally. They are being thrust into a caregiver role they didn't ask for, and they're doing the best they can in something they usually know nothing about. Be a good patient, cut 'em some slack, and show some gratitude. My Recovery Room memories are very hazy. I do remember the surgeon visiting me and saying that the procedure was "very successful". Good. Now back to sleep. I wake later and shortly I'm being wheeled into Post-Op.

In Post-Op with Nausea

In Post-Op, Feeling Good & Able to Take Nourishment

I have a poor memory and sense of time for my initial stay in Post-OP. There are no clocks in view, so I don't have any idea what time it is. Later, I found out that, instead of surgery taking the estimated 98 minutes, it took 2.5 hours! I'm actually feeling pretty good for having just come out of surgery, no obvious pain. At some point, my wife arrives and I'm glad to see her. I kind of drift in and out of wakefulness. After some time, I start feeling nauseated. I vomit twice (into conveniently available bags), dry heaves, while my wife is still visiting me, and the nursing staff administers Reglan, an anti-nausea medication. The nausea is a reaction to the anesthesia medicines. My wife leaves about 8:00PM, after I get sick. I throw up a third time later on and am administered Zofran, another anti-emetic. Time passes. I drift in and out of sleep. My nurse Ruthie comes in periodically to check on me, take my vital signs and temperature, emptying my urine collection bag at the foot of the bed. I barely notice that I have a catheter placed. A BP cuff periodically inflates, forming a counter-rhythm to the IPC leggings which inflate first one leg, then the other. Somewhere in the night, I get sick again and Ruthie gives me more Reglan. August 19, 2011 Time flows, I wake, I sleep. Finally, I'm awake and feeling like the nausea has passed. I'm awake for about 5-10 minutes when I see someone fumbling with the curtain, trying to get into my bay. It's a technician there to take my blood. "What time is it?" I ask. About 4:00AM. I'm awake for maybe another 45 minutes, then sleep. About 6:00AM, additional nursing staff arrives. Much later, a nurse comes by and asks if I want breakfast. "Is it Jello, or real food?" "Real food," she says. "I'll be ready for it in a little while, maybe 15 minutes or so." Food arrives about 7:30AM, a little bit before my wife. It's scrambled eggs, diced peaches, low fat milk, blueberry muffin and cranberry-raspberry juice. But, my wife has brought me a scone from Peet's Coffee Shop. I ask the nurse is it OK to eat the scone? She says, sure. This will become significant later on. My urologist surgeon comes by to see me. I ask for a repeat report on my surgery as I was kind of hazy when I saw him in recovery. He goes over the meds I'm prescribed and future appointments. I'll return to the urology clinic on Monday, August 22 (about 4 days later) to have the catheter removed. "You'll want to take your pain medication before you come in on Monday." That sounded a bit ominous, but really it wasn't. I eat, I'm ready for discharge. Time drags on, so I just sit back and relax and let it go at its own pace. The main nurse comes by and gives us a kit of collection bags (small 3-4 hour bag plus another large bag like I'm using) and paraphernalia for the catheter, explaining quickly how to use them. Sort of as an afterthought, she hands me a breathing exercise device, a Voldyne 5000, without any instructions on how to use it. Some kind of dual-tube device, which was in all night, is removed from my nose. "What was that, anyway?" "That was oxygen." The nurse explains that for the first day or two, I should stick to food that is easy to process: eggs, maybe toast, yogurt, soup, fruit. She said I shouldn't have had the scone my wife brought (uh-oh!). We wait some more. And wait. Finally, about 11:30 AM I'm wheeled down to the Discharge Pharmacy to pick up/get consultation on the meds I'll be taking home. Three of these are "as needed" and the only one I took was the pain medication, as a precaution. I also got an antibiotic and a stool softener, absolutely required. I arrive home about 12:30PM. Continue reading....