HIPEC Surgery Getting Close! Scared! Questions!

[Rheaeliza]

So I met with my surgeon yesterday, which was very comforting. We are on for my HIPEC August 26th...I was wrong in my previous post and my HIPEC will not be done laparoscopically (wishful thinking on my part I guess) it's just that he will start with laparoscopically to get a look inside and make sure there isn't too much peritoneal disease to remove. Then he will for sure be doing the full on, open HIPEC. I loose a chunk of my colon and that stupid stent is coming out (yay, been thinking I can feel it lately), both my ovaries, omentum, and he will be doing something to my liver to prepare it for resection later. Something about tricking it into thinking that half of it is gone so it bulks up in advance of my liver resection.

He said depending on my recovery, I could have liver resection as soon as 3-4 weeks after my HIPEC. I want to get it over with as soon as possible.

So I'm feeling pretty good, 11 days away or so. Doc told me to just really try and enjoy the rest of my summer here, eat what I want, have a few drinks (I'm in pretty good shape and health as is) He says I can expect to be in the hospital for about a week. I have my pre-testing, a PET scan (I have never gotten one ) and meet with anesthesiologist next week on Tuesday the 20th. One thing that I have to decide is if I want an epidural or not? Any advice here? I'm pretty scared of the idea of a needle going into my back!

Also, I'm freaked out about both of my ovaries being removed. Since I had metastatic spread to one ovary, that one comes out for sure. And my surgeon wants to take them both, which I said I'm fine with. I do not think children are in my plan, even pre-cancer, and especially now for me. But the idea I guess is still scary, and I said yes take them both no problem. But now I'm looking at research and stuff and I guess going into menopause and complete loss of fertility at 31 years old is something that is emotionally affecting me more than I thought it would. I'm scared, and I'm sad about it. And I don't know what to expect. Will I regret having both removed? It lowers my risk of reccurance so it's a no brainer? Right? I've been sort of crying every day thinking about it, even though my boyfriend and I do not want children. I guess it's because it sort of puts a finality in that area for me at an age when there shouldn't be one.

Thanks for the support guys!

[SoConfused]

He will be doing a PVE - a portal vein embolization.

The liver is a unique organ because it can hypertrophy (“re-grow”) after part of it has been removed. However, the body does require that a minimum amount of liver be left behind following surgery in order to give the body enough time for this re-growth to occur. Portal vein embolization is a technique used to help re-grow the liver prior to liver resection surgery.

As far as post-op pain management, from what I understand, Epidural is the way to go.

I am very happy that you've reached this milestone on your journey and will be thinking of you and praying for you in the days leading up to your surgery.

[SoConfused]

Check this out ... there is a video of the procedure:

http://www.hopkinsmedicine.org/liver_tumor_center/treatments/portal_vein_embolization.html

[Rheaeliza]

Oh that is a cool video! Thanks!!!

[debb]

Hi...I'm pretty sure that I've read on your posts that your HIPEC surgeon is also mine. If you want to PM me, I can answer any other questions that you might have.

As for the epidural, our doc said I wouldn't need it, but that morning the anesthesiologist suggested it. I was about to be wheeled in, was super scared, and thought if an epidural would help with pain management, then sign me up! I wasn't going to be a hero. But the needle in the back scared me...I've had 4 children without drugs because I was scared of the needle! But cancer scared me more. In my case with HIPEC, our doctor was right, I probably didn't need it. It wasn't kept in post-op, when I could've used it. And I had the unfortunate problem of getting an "epidural headache" which literally lasted for 6 weeks after surgery. Its something that can happen as an after effect of an epidural, because there might have been a leakage of fluid. It happens often in maternity wards, and the fix is easy. They draw blood from your arm and have to stick a needle in your back again, but it causes healing right away. The docs didn't make the connection between my awful headache and the epidural until it was too late and I was home. Brutal ride to NJ from Mt Sinai! The epidural headache is such that you have to lie flat in darkness to alleviate the pain even a bit. But my case was unique, lucky me! So take the epidural if they recommend it and use my story as a cautionary tale, and you'll know what to do if you come down with a head crushing headache that causes you more pain than the incision in your belly!

I had my ovaries removed a month prior to HIPEC. It was this recurrence in my ovaries that prompted me to pursue HIPEC. Losing your ovaries does affect you hormonally, so expect some changes after surgery. Night sweats, hot flashes, mood changes. Sometimes you really don't know whether it's the cancer or the menopause that's causing certain symptoms. But don't be afraid to ask your doc for relief of these symptoms. I finally asked for symptom management and was prescribed celexa, which helped with anxiety, night sweats, hot flashes, etc. I asked for lunesta for insomnia. And I was prescribed Vagifem, a suppository for vaginal dryness. I still cant believe what I have to order and pick up at the pharmacy every month!! I'm now a menopausal insomniac with anxiety issues who needs a lubricant!!
What the heck happened to me?? I used to be a sexy mom who was healthy and organized and happy. Now, I'm a cancer warrior, with all the baggage that goes with it.

You're in good hands at Mt Sinai, and I was out of the hospital in less than 5 days (it's weird because I actually can't remember all the details now..and it was such a big fat deal! I guess that's good). Recovery went well, but that may have been because I couldn't push myself too much because I had that damn headache and had to lie flat all the time. So be good to yourself. Good luck.

[raym]

The number of days you get out is closely related to how quickly your bowels "wake up" after surgery. Until that happens you cannot eat (you will probably be getting IV TPN). From my experience I could not see getting out at 5 days or even 8. It took awhile for the bowels to start moving, then i had issues with nausea. It was to the point where they were going to restart IV TPN in a central line..perhaps that was to scare my body into cooperating. I don't say these things to scare you, but to make sure you are not disappointed if things don't go as expected. The only real issue I had post up was a portion of my incision opening up and it required wet packing for several weeks during and after the hospital. No bid deal, just a pain.

[Ashlee H.]

In regards to the epidural question - here's my story. For my colon resection I had an epidural. The needle in the back was not a big deal. The unfortunate part of it, only 1/2 of me got numb, so I needed the pain pump too. For my liver resection, they didn't do the epidural because they were afraid it would interfere with my breathing - had something to do with the location of the tumor. For HIPEC, we had planned on an epidural, but I was on a blood thinner shot they weren't used to at that hospital, so they were nervous about giving me an epidural since I guess there is a possibility of some bad things that could happen with some blood thinners. I liked how the epidural made me numb, it was kind of weird. Now, after 3 surgeries, my belly is numb all on its' own. Epidurals are nice if they work 100%, but if you don't have one, they can still manage your pain. Almost forgot, during my first surgery is when we discovered I have a real problem with tape on my skin. My back was raw from them ripping the tape off to readjust the epidural. I swear, my back hurt worse than the side they were unable to numb.

[SMR]

My husband also had an epidural for his HIPEC. It seemed that he did better when that was in than on the IV pain meds he had later (in terms of bring lucid). His pain was well controlled by both methods.
Like Ashlee, he has a sensitivity to medical tape. During his first laparoscopic procedure they taped his eyes shut and he ended up with massive scabs on his eyelids which lasted for days. We had to insist they find a better way for his HIPEC surgery, and they ended up using goggles of some sort on him. Best of luck- I'm glad you are able to have this procedure done!

[raym]

Regarding pain management. I had some sort of device that was in my incision that pumped lidacaine from a squeezy bulb. It is called an On-Q pump. It worked great. I also had IV narcotics but got off of then as fast as I cold. IV Torodal (NSAID) was also magic!. I don't recall ever being in pain, just soreness. And yeah, the tape left more scars on my skin than the various incisions for drains and chest tube.

[SkiFletch]

If I could marry the epidural I had during my HIPEC, I would. Don't worry about the placement of it, they give you some benzodiazepenes (valium/lorazepam/versed/etc) before they do the needle to calm you down. Those drugs make it so you can still give them feedback, but you won't care/feel the pain, and you probably won't even remember the insertion. I don't... And for me, it was the best pain control I've had for any medical procedure ever. I never had any pain and was completely lucid through out my recovery. Only had pain after they had to remove it after like 6 days and the narcotics were difficult to manage.

[Rheaeliza]

Thanks so much for all the advice guys.

My skin is super sensitive to tape, my chemo nurses know but sometimes I forget to tell new people like when I get an IV for a CT scan or something and I end up with welts! Hurts way more than the needles!!!

I really appreciate everyone always chiming in with tips and encouraging words. I don't know what I would have done without this forum and all of you over the last year. I have learned so much. It's crazy to think about, but this time, one year ago, I wasn't diagnosed yet but was having symptoms. I thought I had a food allergy!

I knew so little about cancer. I thought "chemotherapy" was like, one drug! Ha! And I thought it was a joke when I got diagnosed, I honestly didn't know that young people got colon cancer. Now I try to convince everyone to get colonoscopies!

[Busymamaof3]

I have to 2nd Fletch's love of the epidural. I felt no pain but was really lucid and able to walk around early on. I too had kiddos with no pain meds and now find it more than a little ironic that I have had so many meds in my body. I wish you well. It is a tough surgery but I believe is a life saving one. Happy to talk in more detail if you want. Just send me a pm. 6 months out I feel fantastic!

[O Stoma Mia]

So I met with my surgeon yesterday, which was very comforting. We are on for my HIPEC August 26th... I have my pre-testing, a PET scan (I have never gotten one ) and meet with anesthesiologist next week on Tuesday the 20th.

Rheaeliza - We will have you in our thoughts and prayers on the 20th and the 26th. For the PET scan, be sure to follow all of the instructions regarding diet, fasting, no exercise, etc., in order to avoid false positives on the test. Is this an ordinary PET scan or a combined PET/CT scan?

[Rheaeliza]

Thanks everyone again for continues support and advice.

I think the PET is combined CT. I had no idea about the no exercise thing but they just called me to tell me.

Can't believe my surgery is only a week away. I treated myself to a dozen oysters, gouda mac and cheese and lobster last night. I'm going to eat so much this week. Also my last chemo was two weeks away now so the effects are wearing off so I should have a week of less digestive woes! I know it sounds funny, but since I generally have to steer clear of too much fiber, that's what I want! I want kale! haha, and a juicy burger!

[raym]

Eat a lot now You will lose a good bit of weight post surgery. Everyone is different but my experience is that it took a long time after surgery to be able to eat decent size meal.

My admittance for HIPEC was scheduled the day after Easter, when we have family members over for dinner. Even though the first day of admittance was a clean out, the doc wanted me on only liquid food the day before that (Easter). I cheated a little but also had made some lobster bisque..liquid enough for me. And me also wanted me to do Mag Citrate the night before admittance...ugh! AND I had a colonoscopy the week before.

Feel free to PM me If you have any questions/concerns and if you would rather talk over the phone I can do that as well.