Percutaneous Nephrolithotomy (PCNL) Surgery – Hip Hip Hooray Leave a comment

Above is a link to a YouTube video that explains this procedure.

Whilst this is keyhole surgery and lesser invasive it is still regarded as major surgery.

PCNL Surgery (planned for 12 April 2022)

It has been a long and painful journey to get here and I am welcoming this surgery as a hope to rid me of the pain I have been in for almost 2 years.  It has been established that it is nothing to do from hip replacement but it has taken all this time to find out and treat the source of the pain. We will see if any pain lingers after recovery but if that is the case I do not know what other tests are available. My past several years have been a round of doctor appointments and tests.

Pre – Op Appointment 6 April 2022

Finally it feels as if things are progressing and there maybe an end to all this pain.

I had just over an hour drive away to get to the hospital and although the drive itself is OK, the pain I’m in right now is really debilitating. The only way to cope is to keep taking the Tramadol. It feels as if I live by the clock in order to get pain relief to a small degree. I am lucky that my eldest son lives nearby and I took a break at his place before driving home.

Tested at Pre-op for Bloodwork and saw the Pharmacy Tech, Nurse and Anesthesiologist

Bloodwork – it is as expected and a sample of blood was taken. This time the needle must have been sharper than Life Labs or indeed the technician was more skilled because I barely felt a thing and for the first time in a long time I was not left with a bruise afterwards.

Pharmacy Tech, Nurse and Anesthesiologist all kind of blur together. I was asked some questions more than once between all of the people.

I was asked about the medications I was taking which currently was 1 Tramadol 3 times a day, 1 Percocet before bedtime and I had recently switched up Meloxicam for Naproxen. I had, however, stopped taking the Naproxen since the 1st of April and had noticed the pain level I was enduring was going less. By the time it was a week of not taking an anti inflammatory the pain level had gone from a 10+ to a 2 or 3. I am on the anti inflammatory for my knee and have been prescribed it for 4 years. when I researched Meloxicam it can cause kidney issues. I decided right then I would not be taking anymore.

I was told it was a general anaesthetic that I would be given. I was thankful for this due to still having numb toes 3 years post hip replacement. I had never had any issues previously with general anaesthetic so there were no worries.  The nurse commented that I was healthy considering I was not on any other medications for other issues such as high blood pressure or diabetes.

I left there feeling optimistic that this was what I needed and found myself looking forward to surgery. No-one looks forward to post surgery pain and recovery but it is a necessary evil that is required. I had got an idea of where to go as well on surgery day because this was not my local hospital and I had to learn.

Covid-19 test – 10 April 2022

At 2 days before surgery I had to travel an hour to a clinic that is across the street from the hospital for a Covid-19 test. I was hoping after all this time that I was not going to be refused surgery due to a last minute hitch (because I already knew how that felt.) There were lots of people waiting for vaccinations but my appointment was in a different building around the corner and badly signed so it was  not easy to find. There were only 2 people ahead of me and 2 technicians so wait was minimal. I was given a paper with a QR code on that linked to a website to check your results within 24 hours.

Glad to say that I was clear and that surgery could go ahead as planned.

Surgery – 12 April 2022

I was told to be there for 12 noon but as I know there is a long walk, at least it feels a long walk with the pain I’m in, and then I have to register on the machine, so we aimed for getting there at 11.30am. We were early because traffic was not as bad as anticipated, so we chilled for a while in the parking lot at Tim Horton’s across the road. Of course, I couldn’t eat or drink anything.

Due to Covid restrictions I was going this alone, so I entered the hospital on my own. there is the usual check in at the entrance where you have to swap out your mask for one they provide and then it was “follow the blue line.” I got to the machine to register my arrival and check-in and noticed that my address was missing a letter in the street line. There was an edit option and I decided to edit it. Not so simple. Nothing ever is. It threw me a ticket to wait in line to be called. It also seemed numbers were being called before my number so I was soon about to get up and question it but I was called. It was to confirm my change with the receptionist before proceeding. She then gave me a wristband for my ID and also a bright red one for my nickel allergy. i think she was trying to cut off my blood supply because the ID band was a tad tight. Later that day a nurse suggested that I rip it off which would make them replace it, but I felt that was a bit too mean, especially when I could tolerate it for 24 hours.

So, of course, you change into a flattering, high fashion hospital gown, ready for surgery and get hooked up to a machine, ready for what is to come. At least the gowns don’t have a back opening for all the world to see your naked bum! Due to restrictions during Covid no slippers or dressing gown were allowed to be taken in. I used my small bag on wheels (that is my swim bag) that I purchased after hip surgery to prevent me from lifting. After a while I was walked down to a waiting area for soon to be surgery patients. the nurses double check you are who you are supposed to be and leave you to wait. I seemed to wait about 90 minutes here and spoke to a lady who was waiting with her son about the length of wait and she explained that she worked there but in a different department and my urologist was the best. i had also overheard a conversation with the mother of a young boy who was being circumcised and I overheard that my urologist was going to help in the surgery. So that told me I was going to be waiting a while longer than I had hoped.

Finally a nurse came to get me and walk me to the operating room. Being English I would have called it the operating theatre. It was a bigger room than I had been in for my hip surgery but they had to fit in a few machines as they guide the tube into the kidney by using ultrasound.

The nurse explained that I would be rolled over once I was “out” and not to be alarmed if there were bruises or marks on my body when I woke up. Right next to the operating table I was on there was another one that had a face mould where I would be lying face down for this procedure. It did seem weird knowing I would be in that. This was possibly why I woke up with an oxygen tube in my nose.

As usual with operations, you wake up not having a clue hoe long the procedure took. It was apparently just under 2 hours by my best estimation. I looked at the clock and it was 1.49pm which immediately struck me as odd how numbers can have significance because that was the exact time my elder son was born by C-section in 1988. The C-section was the first ever operation in my life. As I came round I felt  woozy but good. I know I was pumped with all sorts of pain killers but felt OK. the nurse told me I looked better than most people do after a PCNL. She even told the nurse nearby to look how good I looked. I also think once you are no longer in pain you look better. I was very thirsty and mentioned this so was asked if I wanted a banana popsicle. Best iced lolly I’ve tasted in a long while.

Semi- Private room

Thanks to my husband’s insurance I chose to be in a semi-private room. Just a room with a curtain divider between me and the elderly lady in the next bed.

They weren’t very big on filling out the wall chart that was the only thing on the wall in front of my bed. the lady in the next bed had undergone hip surgery as she had the “do not” riles on her wall. Between the 2 beds there was a notice saying that day of discharge was at 9.30am. If only….

By the time I got to my room I was extremely hungry and was given some kind of sandwich shortly after. You had to ask for water and they did wisely end up bringing me 2 cups at a time. there were several student nurses and I overheard them saying I had been given fentanyl and was now on a morphine drip. the morphine drip, however, took a while to start working properly due to it keep stopping. It was set to drip every 4 minutes but it would stop. It took 3 nurses for one to finally re-calibrate the machine and from then on it was fine. I spent the next day being given a switch up between Tramadol and Percocet until they realised that I needed 2 Percocet every 4 hours, such was the pain I was in. I know they were short staffed and as much as I empathise, asking 4 times and waiting 45 minutes for painkillers is not a good experience.

I did persuade them to remove the oxygen tube from my nose stating I was sure I did not need it. After the student finally got the nurse in charge she agreed. At least that was a little more comfortable.

Dinner this evening was Meatloaf with tomato sauce, which I know is a “thing” here but I scraped off the tomato sauce.  I found it hard to eat due to how I felt but being hungry I just took my time. It was served with roasted potatoes and Italian mixed vegetables. It was followed by pineapple dream pie which was very good and a cup of tea which is always good. Sugar, pepper and salt were provided along with a milkette.

All a milkette is, is a little tiny one serving container of milk, which whilst I drink my tea black, I drank the milk separately.

Post Surgery Day 1 – 13 April 2022

Normally I never have an issue sleeping but this past night was a little different. I was in extreme pain, also in my groin which was possibly due to the catheter but being hooked up to an IV meant that I could not sleep in any other position other than my back and that is not good for me as I cannot sleep that way. it was made worse by the snoring coming from the next bed and also the intermittent moaning and shouting for the nurse. then when the nurses did come they shouted to the lady as I think she was deaf or had possibly removed her hearing aid to sleep. My phone had been plugged into the TV to charge but it was very slow at charging and did not charge at all overnight as the TV was off. The wall socket was so far away the long cord that I brought would still not have been long enough. thankfully I had brought a small mp3 player that clips onto your clothing and that on the lowest volume lulled me to sleep and saved me from the goings- on around me. I slept intermittently though as I needed painkillers throughout the night.

Breakfast was good and was perfect for me. there was a fresh fruit salad which I ate along with the oikos vanilla Greek yogurt supplied. there were also Cheerios and milk. They lost a point from me providing coffee with no possibility of tea (I asked). My room-mate did not want her yogurt and as the nurse was asking her and she refused, I made it aware that I would take it. So I got an extra yogurt which I was happy about.

Discharge from hospital

According to the sign on the wall discharge time was 10am. I was hopeful but I knew it wouldn’t happen that quick as nothing seemed to move very speedily at all.  There appeared to be a lot of student nurses and after Covid I knew the nurses must all be worn out, if not short staffed.

After an early barrage of tests at the bedside I was ready to go home. I had blood pressure tested, blood drawn, dressing changed (it was doing well with no leakage) and finally catheter out. when the nurse came to remove the catheter I was asked if it was OK to have 2 student nurse watch the procedure. I haven’t been in hospital many times in my life but always seem to get the students. In my opinion it’s how they learn so I agreed. A third student tried to ask to join but the nurse told her 3 was too many for a patient. I remember having 6 students watching a procedure in the late 80’s in England so it didn’t faze me at all but she insisted 2 was enough. The relief on taking the catheter out was enormous. They had to check the amount of urine to ensure proper kidney function and as she held it up I was surprised hoe pink it was. I just didn’t think about that but was told it was normal and it was pale so everything was good.

Then I seemed to wait forever. I asked if I was going home that day and was told “probably”. I made it very clear that I was expecting to go home and was in fact cleared by my urologist about 9.30am to go home that day. I was told everything had gone very well with no complications and the stones had been sent to the lab for testing to find out which type of stones they were. As soon as I was cleared to go home, my mission was to make it known I needed to know what was happening as my husband was an hour’s drive away and would need time to get there. That was the reason I felt I could push the issue more.

Lunch came and went at around noon and I pushed even more for an idea of what was happening. By now I was feeling better (still on painkillers) but was not hooked up to anything and was independently able to move and go to the toilet by  myself. There was pain from the stent that had to be left in for a week (more on that later).

My urologist, who had performed the surgery, said he was going to prescribe painkillers (Percocet) until the stent was removed in a  bout a week and that his receptionist would call me with a date to travel back to the hospital for removal.

Finally at 3pm I texted my husband and suggested that he phone the hospital and explain I am supposed to be discharged today and as he was an hour away he wanted to know what was happening. I heard the phone ring, and ring, and ring, and I thought no-one would ever answer it. then a few minutes later she came to tell me that he had phoned and that he was calling back in an hour if they hadn’t called him to tell him to set off. They said it would take a while to get papers together and asked me if I wanted to walk to the entrance or have a wheelchair. I opted for the wheelchair as it was a long walk to the entrance and I didn’t know how I was going to feel up and on my feet. They finally told me at 3.30pm they would call him to tell him I would be ready by 4-415pm and then gave me the option of calling him instead, which is what I did. It sometimes takes a while to get someone to come with a wheelchair and the lady I had was very pleasant and we had a great chat about England.

I had been discharged with a stent in place and of all the pain I have endured the stent pain was one of the worst. I had been prescribed Percocet at 2 or3 a day until the stent came out but I ended up needing the 3 and struggling to resist the urge to take more due to extreme pain. Unfortunately the Percocet was calculated short if taking 3 a day but as I had some left over from pre-surgery I had enough.

Stent removal 19 April 2022

This was a quick procedure and I was about to change into a gown when the urologist saw me in the corridor and said he didn’t mind if I didn’t put a gown on as long as I was OK with that. So it was a quick removal of pants and undies and out it came. No pain, no fuss and immediate relief. Immediate. We went to lunch as it was now that time of day and I enjoyed a pain free lunch for the first time in a long while.

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