Process of Elimination

I realize that THBT has been all “crickets” the past couple of weeks. I know that you all understand how overwhelming life can get. Yet, with that oppression has come some great THBT material. I am calling on all prayer warriors to do your thing—and please ask that my husband doesn't change the locks.

My husband really shouldn’t be angry with me. After all. The last couple of weeks have really been all about him, and rightfully so. He’s been dealing with back pain from a herniated disc for a couple of years, and he was finally able to surgically address that with a procedure called a laminectomy. In short, a part of the bone on the spine is removed to make room for the disc herniation so it no longer presses the nerve against that part of the bone. It’s a pretty intense surgery, so he’s going to need quite a bit of recovery time. But the first week? Boy, was that fun…

My hubs has a high tolerance for pain. This also means that it takes a little higher dose of pain medication to alleviate his discomfort. He is also 6’ 4” and weighs blahblahblah. And I can guarantee that much more anesthesia was used on him that on Captain Lightweight over here. Hubby was pumped up with five different IV pain medications in the PACU (post anesthesia care unit), four of which were narcotics, to control post-surgery pain. And—I want you to remember this statement for later—they did not treat his bowel. THEY DID NOT TREAT HIS BOWEL. Just hold on to that tid-bit of information.

Hubby is also in and out of sleep—not because of noise, or pain, but because this poor guy, so large in stature, is in a stretcher made for Froto the Hobbit, and the second he dozes off and relaxes, an arm falls off the side. He is startled awake enough to pull it back on and relax again when the other arm takes its turn, interrupting his rest. I ask for pillows and tuck them under his arms to prevent this from happening. I am so smart. I go to tell the nurse how smart I am, and I run into his feet that are hanging off the end of the stretcher. Instead of being boastful, “Don’t you have bed extenders?” comes out, knowing full well what the answer is.

After he is moved out of PACU to a recovery room, we are surprised to hear from his teeny tiny nurse that they are considering letting him go home that evening. But there are two stipulations: he must walk, and he must pee. Challenge accepted! Nurse Tinkerbell gave him oral pain medications, and once those kicked in, she and I helped him get up slowly, and he was able to grace the halls with his presence, ever so slowly. Then off to do what hubbies do best! He was required to pee in a plastic urinal so it could be measured.  No problem. Well, at least we THOUGHT there wasn’t an issue. Ten minutes later…

Husband comes out of the bathroom, hands me the urinal: “There, I peed.”

Me: “That’s not very much, honey.” I might be able to use it in a cornbread recipe, but that wasn’t getting him home.

Husband: “Well, I don’t have to go anymore. Let’s give it to the nurse.”

She comes in, already toting the bladder scanner. After seeing the cup and a half of urine, she said “Let’s see if you left any in there.”

Cold gel. Swirly device on belly. 829 ml. I didn’t have the heart to tell him he had about half a two-liter bottle of soda in his bladder.

Nurse: “You still have a looooot of pee in there. You need to pee some more.”

Hubs: “But I don’t feel like I have to go!”

He repeated this process, this time with the water in the bathroom running. He got another 200 ml. Doc gave him till 730pm to empty his bladder below 300ml if he wanted to go home.

Hubs: “If I am going to be in pain, I want to be in my own bed where my arms and legs actually fit in it. Let’s get this show on the road!”

More walking, some wifey bladder massage, and honestly, the age-old slumber party trick of hand-in-warm-water actually worked. 680 ml. Bladder scan, 259 ml.  We’re outta here!

But WHY was this so difficult?

Both the opioid pain medications and the anesthesia affected the nerves that control the bladder’s ability to contract. Urinary retention after surgery is common—and honestly, my husband is pretty lucky he was able to pee so quickly. Retention after surgery can last days and even weeks after surgery, requiring people to go home with an indwelling catheter. Yikes.

Now think back to the thing I asked you to remember. Earlier this year, I spent an entire month talking about poop, and I’m sorry, not sorry, that I am addressing the subject again. Since hubby has been dealing with this back pain for quite some time, he has been dealing with many different pain medications, and yes, some are opioids. When they are used as directed and under the care of a physician, they are safe. But please do yourself a “solid” (haha) and buy an over-the-counter stool softener to take with it. My husband had a very good system down, that is, until he went under anesthesia and was then given several opioids via IV. Anesthesia paralyzes the muscles in the colon that work to move stool along, and although opioids work similarly in that they slow this process, they also encourage the body to absorb more water from the stool, making it hard and firm and difficult to pass.

Husband-creature was given nothing to treat his bowel on the day of his surgery—the day he had the most medication. This was on a Monday. By Friday, the pressure build-up in his abdomen was so intense, his back pain was no longer his major complaint. He took 400mg of Colace (stool softener) daily, used 2 glycerin suppositories, drank two 10ml bottles of magnesium citrate, and used two fleets enemas between Monday and Friday. This may or may not mean anything to you, but just know a blow-out should have been imminent.

But nothing happened.  NOTHING.

Misery was too soft a word to use to describe what he was experiencing. At that point, I contacted our PCP and asked for help, because the next step was a nasty, nasty procedure in the ER called disimpaction, and it is one of those medical words that is underlined in RED in Word because it doesn’t recognize the medical term—either that or it’s underlined just because it is so disturbing that it doesn’t want me to put it out there. I asked him for Lactulose—which, if hubby’s process above should have caused blow-out, Lactulose would be volcanic eruption. It was welcome at this point.

I must have scared my husband’s colon using the “L” word. When I returned from the pharmacy with operation volcano in a bottle, hubs had already had the relief he had long been waiting for. So, there it sits. Lactulose. On hubby’s nightstand. Staring. At his colon. It WILL behave.

Take from this that elimination is important, how anesthesia and opioids affect that process, and how to stay ahead of it. My wonderful husband is completely aware that I am writing about him. He loves me. He is supportive.  And he, too, wants you to…

Be Well!