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Recovering from total abdominal hysterectomy - bilateral salpingo-oophorectomy, and pelvic node dissection
We dedicate this book to all of the women who have entrusted their care to us. By allowing us to take part in their surgery and after care, they have shared an important time in their lives with us and taught us a great deal.
Contributors:
Physicians: Dr. L. Elit, Dr. F. Moens, Dr. J. Mazurka Nurses: Betty Anne Lane, Tracey Mullen, Heidi Thomas, Christine Schlosser Kelly Drake Medical Secretary: Joanne Ricciardone Patient Education Services, Hamilton Health Sciences
Hamilton Health Sciences, 2007 and 2010.
Table of Contents
Page
Part 1: Learning about the surgery ............................................. 3
Part 2: Learning about your hospital stay and your health care team ..................................................... 15
Part 3: When you go home ........................................................ 29
This book contains the answers to the most common questions women have about total abdominal hysterectomy bilateral salpingo-oophorectomy and pelvic node dissection. It also provides information to help you recover in the hospital and at home. This book will not replace talking with your caregivers, but may make it easier. Please share your concerns with us, write down questions you wish to ask the Health Care Team.
Questions: ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
Recovering from total abdominal hysterectomy bilateral salpingo-oophorectomy and pelvic node dissection
Part 1:
Learning about the surgery
What is a total abdominal hysterectomy bilateral salpingooophorectomy and pelvic node dissection?
There are 3 parts to this surgery: 1. A total abdominal hysterectomy, or TAH, is the removal of your uterus or womb and the cervix. 2. Bilateral salpingo-oophorectomy, or BSO is the removal of your fallopian tubes and ovaries. 3. Pelvic node dissection is the removal of lymph nodes in your pelvis. There are many lymph nodes throughout your body and not all of them will be removed. Only a sampling of lymph nodes will be taken, and sent to the lab. 4. Some women will also have a panniculectomy at the time of surgery. This is the removal of a large fat pad which allows the oncologist to perform the surgery more safely.
fallopian tubes myometrium
uterus ovary cervix vagina
What is the reason for my surgery?

This surgery is needed whenever there is evidence of cancer or possible cancer in the uterus. This is most often determined before surgery by a biopsy done in your gynecologists office. The most important reason for surgery is to remove the uterus which may be cancerous and to take samples of other areas and tissues in your abdomen. During the surgery, the surgeon will check the liver, spleen, diaphragm and all the surfaces in your abdomen. This is to see if these organs are healthy. For this reason, your incision may be up and down from the pubic hairline to several inches above the belly button. For those having a panniculectomy the incision is from hip to hip. After the surgery a doctor called a pathologist examines all of the tissues that were removed under a microscope. This is done to detect any possible cancer cells and to determine the extent of any cancer found. The pathologist needs to look at the tissues very carefully to give your oncologist all the information that is needed. This can take up to 3 to 4 weeks.
Your doctors and other health care providers will discuss the results of these tests and any treatment plans with you as soon as possible after the surgery. Sometimes, surgery is the only treatment that is needed. Other times, further treatment such as chemotherapy or radiation may be needed. Each persons treatment plan is designed for their type of disease.
What does it mean if there is cancer left inside after the surgery?
Surgery is done to remove most if not all of the cancer. Sometimes, this is not possible. On occasion the cancer and organs are stuck together, and it is too difficult or dangerous to separate them for removal. Other times, small bits of tumour called seedlings are scattered over such a large area that it is next to impossible to remove them all. In these cases, your doctor will recommend chemotherapy or radiation to shrink or kill any remaining cancer cells.
What fills the empty space when everything is removed?

Normally, the uterus, ovaries and tubes fill a space in your lower abdomen about the size of your hand. The small bowel or intestines are just above. After surgery, the intestines will dip down to fill the space.
How long will I be in the hospital?

A usual hospital stay is 3 to 5 days.
How long does recovery take?

Total recovery has 3 parts: physical, emotional and sexual. These 3 parts of the recovery period may happen at different times.
Physical Physical recovery includes healing of the skin and abdominal muscle incisions and a return to your normal energy level. This can take 6 to 8 weeks. At the end of this time, most women will be back to their usual work and social activities.
Emotional Emotional recovery may mean adjusting to the shock of having cancer, to being away from home and to believing you can become well again. It also means feeling comfortable with yourself and the changes in the appearance of your body after your surgery. Emotional recovery may happen at the same time as physical recovery, or it may take longer.
Sexual Sexual recovery involves a return to your previous patterns of lovemaking, or making changes that fit with you and your partners needs. The other sexual organs, the vagina and the brain remain the same. So does your normal human need to feel loved and cared for.
If you would like, we can talk with you about positions and activities that can help you and your partner enjoy a comfortable relationship. The length of time for this recovery varies, but it is possible with patience and care. It can take 1 to 3 months, but it is not unusual for it to take longer.
What changes will there be sexually?

Most women report few sexual changes as a result of this operation. Healing of all incisions usually takes 6 to 8 weeks. After that, it is possible to start having intercourse again. Of course, affection and touching are possible before that time if you wish. This surgery will not change a womans ability to have satisfying sexual relations or change her level of interest in sex. Women may notice the following changes: The vagina may be shorter in its relaxed state if the top section has been removed with the uterus. As the vagina is very stretchy, most people cannot tell the difference during lovemaking. In the aroused state, the vagina naturally lengthens.
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The operation should not affect your ability to have an orgasm or sexual climax. However, a climax causes muscle contractions in the uterus as well as other parts of the body. Since the uterus is no longer there, some women have said there is a slight difference in their orgasms. If menopause had not previously started, it will now. Many women find the vagina does not get as wet as it did before menopause. It is therefore a good idea to spend more time becoming aroused before lovemaking so the vagina can lubricate. It also helps to use a water-soluble lubricant such as K-Y Jelly. Oil based lotions and vaseline will not flow freely out of the body and should not be used. A cancer diagnosis and surgery can be stressful. If you have been tired, anxious or worried, you may find that your interest in sex is decreased. Talking to your partner or health care providers along with time and patience will often help your sexual feelings return. By 6 months, most women report a return to their usual lovemaking.
11
Will I have a lot of pain?

This is a common concern. However, the more comfortable you are, the quicker you will recover. Comfort also allows you to take an active part in getting well again. During your pre-op visit, the anesthesiologist will talk to you about pain control. There are 2 main types of pain control used after surgery: Patient Controlled Analgesia, or PCA and Epidural Analgesia. You will most likely have one of these types of pain control when you wake up after surgery.
Patient Controlled Analgesia, or PCA PCA consists of a mechanical pump that delivers morphine by intravenous (IV) when you push the button. There is a dose and time limit set on the pump so you do not have to worry about giving yourself too much morphine. As well, when morphine is used to control pain after surgery there is no need to worry about becoming addicted to it. You will find that you may use it a lot the first day or so and then less each following day. Patients usually have a PCA for 2 to 3 days after surgery.
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Epidural Analgesia Epidural Analgesia consists of a small tube placed in your back by the anesthesiologist during your surgery. The tube is then taped to your back and over your shoulder. A special pump will deliver medication continuously so that you will feel less pain in the surgical area. Some patients have slight numbness or heaviness of one or the other thigh/leg. This is normal and will be closely watched by the nurses. Your strength and sensation will get better once the epidural is taken out. You will still be getting up and walking with the epidural in place after surgery. Patients usually have an epidural in for 2 to 3 days after surgery.
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14
Part 2:
Learning about your hospital stay and your health care team
15
16
This part of the book describes your care in the hospital. The goal of care is to help you recover and to prepare you for going home. A number of people will be involved in your care. They are all part of your health care team. The most important person on the team is you. You will take part in your care too. A team needs to work together.
Who is my main doctor? I have met so many

Your doctor is a specialist called a Gynecologic Oncologist. At the Cancer Centre, the Gynecologic Oncologist reviews your medical history to get a full picture of your situation. One of his/her roles in your care is to coordinate other surgeons so that you get the best possible care. These surgeons may look after women who need their surgery skills, but do not have cancer. Before your surgery and depending on your needs, he/she may ask other doctors to see you. These doctors are from: Anesthesia, Respirology or Internal Medicine for example. When you leave the hospital, a Gynecologic Oncologist will see you in a follow up clinic for a length of time to make sure that your treatment has been complete.
17
Who does my surgery?

A team of Gynecologic Oncologists do the surgery. Everyday one of the members of the team will visit you to see how you are doing and plan your post-operative care. Your care plan is reviewed with other doctors and nurses. The team also works with social workers, nutritionists and physiotherapists to make sure all of your needs are met.
How will the nurses help my recovery?

Nurses will be available to guide you every step of the way. They will prepare you both physically and mentally for your operation and recovery.
What should I expect before surgery?

Planning ahead It is also important to plan for your healthy recovery before surgery. Be sure to get groceries and banking done a few days before your surgery.
18
Also, arrange for help with meals, child care, pets, gardening and housework because rest is most important for the first few weeks after surgery. Be sure you have someone to drive you where you need to go. After surgery the doctor may not advise driving for a couple of weeks.
Pre-op clinic Up to 2 weeks before your surgery you will be seen at the Pre-op Clinic at the Henderson Hospital. There, the nurse will review your surgery and ask you specific questions about your health. You will have blood taken as well as a chest x-ray. An EKG (electrocardiogram) may also be done to check your heart. The team needs this information to plan your care. The information is also helpful to see your progress as you heal. The nurse will also review with you: The consent form you signed at the doctors office How to clean your bowels out before surgery When to stop eating and drinking before surgery What medications you take the morning of your surgery What tubes and drains you may have after surgery such as a urinary catheter a soft tube in the bladder to drain urine into a bag
19
The pre-op nurse will also teach you the deep breathing and coughing exercises and leg exercises that you will need to do after surgery. Doing these will help you keep your lungs healthy and reduce the risk of pneumonia and blood clots (see pages 25 to 26). You may want to practice these exercises before your surgery.
Just before surgery have a shower or bath remove nail polish from fingers and toes remove all jewelry including body piercing
On the day of your surgery On the day of surgery, you will go to Same Day Surgery Unit at the Henderson Hospital. There they will take your belongings and put your name on them and take them to the area you will be staying after surgery. It is important not to bring anything of value (money or personal). All rings and jewelry must be taken off before surgery, so it is best to leave them at home or with a family member for safekeeping.
20
You will change into a hospital gown, empty your bladder and remove your dentures and contact lenses if you wear them. An intravenous, or IV will be started to give you fluids and some medications that are needed before, during and after surgery. You may receive some medication to make you sleepy. Once these preparations are completed, you will go to the holding area about one half hour before your surgery. Usually, one person may stay with you at that time. We cannot be sure of the exact time of your surgery. The time may be slightly earlier or later than planned. Once you go into the operating room, your family members can wait in the waiting room to talk to the surgeon after the surgery. If your family wishes to speak to the doctor after surgery, please let the doctor know. After the surgery, you will go to the recovery room where the nurses will look after you. When you are fully awake, you will go to the ward to complete your recovery. As routine, some women go to the Intensive Care Unit (ICU) after the surgery. Your doctor will tell you if this is necessary.
21
What should I expect after surgery?

As you recover from your surgery, the nurses will provide the following care: Review pain control options with you to help maintain a level of comfort. Remember, pain is an individual experience and cannot be compared to others. Watch for drainage from the incision after surgery and change your dressing as often as needed to promote healing. It is not unusual to have the dressing removed the day after surgery and left uncovered. Usually there is only a small amount of reddish pink drainage from your incision. Check for vaginal bleeding. A pad is worn to check for this as well as for comfort. You may use ice chips soon after surgery to keep your mouth moist and to help prevent nausea. The next day you will receive clear fluids. Gradually your diet will increase, when your bowel function returns to normal.
22
Maintain your IV. IV fluids are needed until you are drinking enough to meet your bodys needs. As well, an IV provides a way for the nurse to give you medications to help prevent or treat nausea, heartburn, itching or antibiotics if needed. Encourage you to do leg and breathing exercises every 2 hours while awake. On the day after surgery, your nurse will help you get out of bed and into a chair. You will start walking short distances and your nurse and other members of the health care team will urge you to increase your activity a little each day. They will show you how to support your abdomen when getting out of bed so you do not put any stress on your incision. Clean and care for the bladder catheter tube until your bladder can work normally again. The catheter is in place for about 24 to 48 hours. Some women may have a drain along the incision, especially after a panniculectomy. These help prevent a fluid collection which may develop under the incision. These drains usually remain in for a few days. If you are ready to go home before the drains are ready to come out, home care will be set up for you to help you care for them at home.
23
Give you a warm blanket for your abdomen. Bowel activity is slow at first and many women feel bloated and have gas pains. Pain medication helps but walking is most effective to help get the gas moving and ease the discomfort. Give stool softeners so your bowel movements will be soft and easy to pass so as not to put added strain on the incision area. Give a blood thinning medication by needle in your upper thighs to help prevent blood clots from forming. This medication will be stopped as soon as you are walking regularly.
For several days after your surgery, your activity will be less than normal. During this time, your lungs breathe more shallowly at rest. Fluid build up may occur in the lungs. This could lead to complications, therefore it is very important to do the following:
24
Breathing exercises 1. Take a slow deep breath and fill your lungs. Hold the breath for a count of 3. Slowly blow out. 2. Repeat 8 to 10 times each hour. 3. Cough 3 times after your finish deep breathing. Remember to hold your incision with a pillow or folded blanket.
Change your position every 2 hours. Lie on opposite sides, change the height of the bed or sit up in a chair.
25
Leg exercises These need to be done every 2 hours while awake. 1. Tighten the buttocks. Hold for a count of 5. Relax. Repeat 10 times. 2. Lie with legs straight. Tighten your right leg muscles and push knee down into the bed. Hold for a count of five. Relax. Repeat 10 times. Now repeat the exercise with the other leg. 3. Turn your ankle in a circle 10 times in one direction then 10 times in the opposite direction. Do this first with the right foot, then the left. Flex your foot up and then point your toes down. Repeat 10 times each foot.
Walk You must walk several times a day to regain your general strength. A nurse or family member can help you push the IV pole. Increase the number of times you walk as well as the distance each day. The nurses plan your care according to your individual needs. We encourage you to help us plan your care. We are happy to answer any questions regarding your care and hospital stay.
26
How important is nutrition?

Nutrition plays a major role in your recovery. Good nutrition can help give you energy and strength. A balanced diet of protein, fruit, vegetables and whole grain will help your body heal. Your diet can also prevent problems with your bowels. Eat foods high in fibre such as bran, whole grains, fruits and vegetables to keep your bowels healthy and regular once your bowels have returned to normal. If you have any questions about your diet, please write them down and ask your nurse or doctor.
What does the Social Worker do?

A new diagnosis of cancer and treatment can be frightening. Patients and families often have very strong and upsetting feelings at this time. The social worker can help you recognize and express those feelings. Sometimes the illness and recovery can affect your role in the home, either as breadwinner, spouse or caretaker of older parents, or dependent children. The social worker is aware of the turmoil this creates in the family and can support you in finding other sources of help.
27
During your hospital stay and recovery, you may be entitled to sick benefits either from your employer plans or other sources. The social worker can help you sort out your benefits. A social worker is available on request from yourself, your family or your health care team.
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Part 3:
When you go home
29
When you go home

Most patients are ready and eager to go home 3 to 5 days after surgery. If you go home with staples in your incision, you will need to go to your family doctors office to have them removed. Your health care team will advise you if this is needed. Your oncologist will give you a prescription for pain pills. When you have less pain, you may prefer to take plain Tylenol. If you find that an activity gives you pain, stop and rest. Wait a few days before trying that activity again. Some people heal more slowly than others. If you still need nursing care for your incision, home care will be provided. Your incision should be a clean, dry, and closed line. Look at your incision before you leave the hospital so that you will be able to see if there are any changes to it when you are at home. You may have a shower to help keep your incision clean and to help it heal. You may have a bath for the first few weeks, but for the first few weeks patients usually prefer showers. Be sure to completely and carefully pat dry your incision after washing. Use a clean cloth and towel each time you bathe.
30
After your surgery, you may feel a little discomfort when passing urine. Be sure to drink 6 to 8 glasses of water or other clear liquids, such as cranberry juice, each day to help prevent problems. Once home, you can continue to increase your activity level slowly. Remember that your need for relaxation and rest will still be greater than normal. At first you may find activities such as climbing stairs, lifting your children or vacuuming too hard for you. If you feel tired, stop and rest. Exercise can help your recovery as well. Walking is an excellent exercise that is tolerated by most patients. You can gradually walk farther or faster each day.
You use a lot of emotional energy during a cancer diagnosis and surgery. Rest and relaxation will help your recovery. Activities you enjoy will also renew your energy and sense of well being. Relaxation techniques learned in hospital can help recovery at home too.
Many patients also strongly believe in the power of prayer. You may or may not be religious, but your spiritual beliefs can bring peace of mind as you recover. A hospital chaplain is available upon request during your hospital stay.
31
What is CCAC?
CCAC stands for Community Care Access Centre. CCAC is a program, which arranges nursing, physiotherapy, nutrition and social services when you go home, if needed. Other needs which the program provides include: Drugs, dressings and medical supplies Hospital and sick room equipment
The CCAC case manager will meet with you to review your needs so that the appropriate services can be provided once you are home. If you are not eligible for the program, the case manager can help find other sources of care. You may need to make arrangements with friends and family to help you during your recovery. Not all patients will need CCAC once they go home.
How does CCAC help?

CCAC helps the healing process continue in your own home. If you need professional care when you get home, the doctor will ask the Home Care Co-ordinator to see you. If you think you will need more help and it has not yet been mentioned, tell your nurse or doctor of your needs and concerns.
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Follow-up visits
You will be given an appointment for a follow up doctors visit before you leave the hospital. Regular follow up appointments are made in the Cancer Centre. You will be seen a few weeks after your surgery and your Gynecologic Oncologist will determine how often you need to be seen there after. These visits may vary from a single visit to a few times per year or yearly, depending on your personal situation.
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When to call the oncologist

Call the oncologist if you have: fever higher than 38.5oC or 101.3oF chest pain, cough, difficulty breathing or coughing up blood pain, swelling or tenderness in your calf or thigh dizziness for more than a few seconds or fainting concerns about your incisions such as: swelling, hardness or leaking redness, bleeding or drainage pain, which does not get better with pain pills urinary frequency, burning or bleeding when you pass urine any bright red bleeding or clots from your vagina that looks like a period or soaking more than one pad every hour or passing clots of blood from your vagina foul smelling discharge from the vagina, an increased amount of discharge
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Phone numbers
Office: 905-389-5688
Doctor: ________________________________ Nurse: _________________________________ Follow-up appointment: ___________________
Questions to ask at my follow-up visit:

_____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________ _____________________________________________________
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Hamilton Health Sciences, 2007 PD 5703 - 05/2010 dt/May 12, 2010 WPC\PtEd\LrgBk\TotalAbdomHysterBilateralSalpingoPelvicNodeDissection-th.doc

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Recovering from total abdominal hysterectomy - bilateral salpingo-oophorectomy, and pelvic node dissection

Hamilton Health Sciences, 2007 and 2010.

Part 1: Learning about the surgery ............................................. 3

Part 3: When you go home ........................................................ 29

uterus ovary cervix vagina

What is the reason for my surgery?

What fills the empty space when everything is removed?

How long will I be in the hospital?

How long does recovery take?

What changes will there be sexually?

Will I have a lot of pain?

Who is my main doctor? I have met so many

Who does my surgery?

How will the nurses help my recovery?

What should I expect before surgery?

What should I expect after surgery?

How important is nutrition?

What does the Social Worker do?

When you go home

How does CCAC help?

When to call the oncologist

Doctor: ________________________________ Nurse: _________________________________ Follow-up appointment: ___________________

Questions to ask at my follow-up visit:

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Doctor: ________________ Nurse: _ Follow-up appointment: ___